LIBRARY OF CONGRESS. 

T\ t a- t — 

Chap, Copyright No. 

Shell _£*:„% % ■ 



UNITED STATES OF AMERICA. 



A COMPENDIUM 



OF 



PRACTICAL MEDICINE 



FOR THE USE OF 



Students and Practitioners of Medicine 



WILLIS WEBSTER GRUE-E, A. M., M. D., 

Professor of Physiology and of Clinical Medicine in the Toledo Medical College; Visiting 
Physician to the Toledo Hospital; Physician to the Toledo Medical College Dis- 
pensary for the Relief of the Out-door Poor ; Member of the American Medi- 
cal Association; Member of the Tri-State Medical Association; 
Member of the Toledo Medical Association, etc., etc. 






TOLEDO, OHIO: 

The Hadley Publishing Company. 
J897. 



^-v 



COPYRIGHTED 



W. W. GRUBE, 

1897. 



PREFACE. 

Ill presenting this volume to the medical profession, it may 
not be improper to state the circumstances which led to the 
undertaking, and the design which it is intended to accomplish. 

The frequent requests on the part of medical students whom 
it has been my pleasure to instruct during the past few years, to 
prepare a compendium of practical medicine which shall aid 
them in acquiring established facts, is the only apology I have to 
offer for its appearance. 

This work is designed to present the leading facts and prin- 
ciples of medicine, in a brief, clear and concise manner, so that 
they may be readily comprehended. My chief aim has been to 
prepare a book of an essentially practical character — one neither 
so meager in detail as to be next to useless, nor so overladen with 
unnecessary matter as to be unwieldy and lacking in precise 
knowledge. The ever- recurring wants and requirements of the 
medical student and practitioner have been kept constantly in 
view. 

In the preparation of the work, the author has carefully 
examined all the best material at his command and freely used 
it; the special object being to have it abreast of the present 
knowledge on the subjects treated as far as such is possible in a 
work of this kind; and every effort has been made to give it all 
the freshness of interest and clearness of expression possible. 

The discussion or even mention of mere theories has been 
purposely avoided, for experience has taught us that such dis- 
cussions serve only to confuse and discourage. In issuing a 
volume of this character, it is perhaps but just to say that of 
course it cannot and is not intended to replace the classical 
works. For more minute information, extended description and 
elucidation and other minutiae for which the work of reference 
is consulted, recourse must be had to more extended text -books 



PREFACE. 



and similar sources of information. Nevertheless, it is confi- 
dently believed that the present volume meets a distinct and im- 
perative need of the medical student and general practitioner, 
conveying in condensed and convenient form concise and practi- 
cal information for which they are liable to have continual use. 

In my endeavor to keep this book within reasonable limits, 
I have touched but lightly upon the pathology of disease, except 
in those cases in which such knowledge would aid in the treat- 
ment, and have purposely omitted all unimportant details. Not- 
withstanding my utmost efforts at condensation, the work has 
grown beyond the contemplated size. 

Much of the matter embraced in a work of this kind is 
the common property of the medical profession, and credit has 
been given for facts or opinions by merely inclosing the name of 
the author in parenthesis. If I have failed to give credit in any 
case, it is unintentional. 

I would gladly acknowledge my indebtedness to Prof. J. H. 
Pooley, M. D., of Toledo, for the preparation of Chapter IV., 
on "First Help in Surgical Emergencies," and to Prof. W. J. 
Gillette, M. D., of Toledo, for the preparation of Chapter III., 
on "Medical Diseases of Women." 

I also acknowledge my indebtedness to the standard works 
of Bartholow, Loomis, Flint, DaCosta, J. L. Smith, Skene, 
Thomas, Pozzi, Anderson, Fox, Noyes, Milton, Keyes, Bosworth, 
Bryant, Lusk, Habershon, Starr, Hammond, and many others. 

To the many kind Mends who have encouraged me to un- 
dertake this work, I return my warmest thanks. 

W. W. GPvUBE, M. D., 

1502 Collingwood Ave., 

Toledo, Ohio. 

March, 1897. 



CONTENTS AND GENERAL INDEX. 

Examination of the patient. 17. History of. 17. Present condition. 17. 
Position of body. 18. General aspect. 18. 

PAGE. 

The Skin in Disease 19 

The Pulse in Disease 19 

The Tongue in Disease 24 

The Temperature in Disease 27 

Chronic Fever 30 

Clinical Index 649 

Fee Bill 664 



Abortion , 32 

Abscess 37 

Acidity... 40 

Acne 41 

Acne Rosacea 45 

Addison's Disease 46 

After-pains 47 

Agalactia 48 

Ague (See Intermittent Fever)... 48 

Ague-cake 48 

Albinism 49 

Albuminuria 48 

Alcoholism 50 

Alopecia 51 

Amaurosis 53 

Amblyopia 53 

Amenorrhcea 610, 53 

Anaemia 56 

Anaesthesia 62 

Anaesthetics 635 

Anasarca 60 

Anchylosis 62 

Aneurism 58 

Angina Pectoris 60 

Anthrax 61 

Aphasia 64 

Aphonia 70 

Apoplexy 64 

Aptha? 63 

Appendicitis 66 

Ascaris Lumbricoides 70 

Ascites 66 

Asphyxia 72 



Asthenia 69 

Asthma 6? 

Atheroma 72 

Backache 73 

Balanitis 73 

Baldness 73 

Basedow's Disease 73 

Bed-sore 73 

Biliousness 74 

Bites 75 

Bladder Diseases 76 

Blepharitis 76 

Bloody-flux 76 

Blood-poisoning 77 

Boils 76 

Borborygmus 78 

Breasts, Inflammation ol 78 

Breath, Foul 77 

Bright 's Disease 83 

Bronchitis 79 

Bronchocele 78 

Bubo 84 

Bubonocele 7 s 

Bunions 86 

Burns and Scalds 62-3. 87 

Calcification 141 

Calculi 89 

Cancer 95 

Cancrum Oris 132 

Carbuncle 100 

Cardialgia 133 

Caries 99 

Catalepsy 133 



XII. 



GENERAL INDEX. 



Catarrh, Nasal and Chronic Gas- 
tric 100 

Cephalalgia 134 

Cerebro-Spinal Meningitis 134 

Chancre 109 

Chancroid 110 

Chicken-pox 135 

Chilblains 112 

Chiragra 220 

Chloasma 141 

Chlorosis 113 

Cholera Infantum 116 

Cholera Morbus 115 

Chordee ,,,, 118 

Chorea 120 

Circumcision 135 

Cirrhosis of Liver 143 

Cold, Exposure to 626 

Cold Feet 137 

Colic 121 

Coma 136 

Comedones 140 

Condylomata 123 

Conjunctivitis . 124 

Constipation 125 

Convulsions 127 

Copper-nose 45 

Coryza 128 

Cough 137 

Cramps 142 

Croup , 128 

Cystitis 131 

Cysts 140 

Dactylitis 164 

Dandruff 164 

Debility 143 

Delirium 144 

Delirium Tremens 145 

Derbyshire Neck 164 

Diabetes Insipidus -. 146 

Diabetes Mellitus 147 

Diarrhoea 149 

Disl ocations 627 

Dyphtheria 151 

Dypsomania 154 

Dirt-eating 155 

Dropsy 155 

Drowning 627-1 64 

Dysentery..., 157 

Dysmenorrhea 613, 159 

Dyspepsia 161 

Earache 164 

Eclampsia 183 



PAGE. 

Eczema ' 165 

Embolism 184 

Emissions 169 

Emphysema 172 

Empyema 173 

Endocarditis 175 

Endometritis 620, 186 

Endosteitis 392 

Enteralgia 190 

Enteritis 176 

Enuresis 184 

Ephidrosis 190 

Epididymitis 187 

Epilepsy 178 

Epispadias 189 

Epistaxis 180 

Epithelioma 189 

Eructations (Offensive) 189 

Erysipelas 181 

Erythema 183 

Exophthalmic Goitre 213 

Faintings 199 

Falling Sickness 199 

Fatigue 200 

Felon 199 

Fetor of Axilla and Feet 191 

Fevers (in general) 191 

Fissure of Anus. 192 

Fissure of Nipple 194 

Fistula 195 

Fits 199 

Flatulence 196 

Flooding 199 

Flushing Heats 200 

Foreign Bodies in Eye, Ear, and 

Nose 628 

Fractures 267-201 

Freckles, Sunburn and Tan 197 

Frostbite 198 

Furuncle 199 

Galactorrhea 202 

Gall-Stones.. 208 

Gangrene 203 

Gas, Asphyxiation from 629 

Gastralgia 206 

Gastric Ulcer 207 

Gastritis (Toxic) 223 

Giddiness 226 

Gingivitis 224 

Glanders 226 

Glands, Enlarged Lymphatics.... 210 

Glaucoma 224 

Gleet 211 



GENERAL INDEX, 



XIII. 



Glycosuria . 227 

Goitre 213 

Gonagra 227 

Gonorrhoea 215 

Gout 220 

Granulating Lids 226 

Gravel 226 

Graves' Disease 226 

Green Sickness 226 

Grocers' Itch 165 

Gumma 226 

Gums (Spongy) 223 

Hematocele 259 

Hremidrosis 260 

Haemoptysis 230 

Hemorrhage 630, 239 

Hsemateniesis 227 

Hematuria 228 

Hay Fever 232 

Headache 234 

Head-injury 262 

Heart-burn 237 

Heart Diseases 238 

Heat Stroke 255 

Hectic Fever 256 

Hemicrania 237 

Hemiplegia 237 

Hemorrhoids ..,,.,... 242 

Hepatitis 244 

Hernia 630,263 

Herpes 245 

Hiccough 247 

Hives 257 

Hoarseness 257 

Hodgkin's Disease 261 

Hordeolum 258 

Horns 262 

House-maid's Knee 258 

Hydrocele 259 

Hydrocephalus 248 

Hydr@nephrosis 272 

Hydrophobia 274 

Hydrothorax 249 

Hymen-Imperforate 261 

Hyperidrosis 260 

Hypochondriasis 250 

Hypospadia 261 

Hysteria 252 

Icterus 296 

Icthyosis 275 

Impetigo 276 

Impotence 279 

Incontinence of Urine 282 



Indigestion 277 

Inflammation 277 

Influenza 282 

In-growing Toe-nail 284 

Injuries to Brain 631 

Insolation 296 

Insomnia 284 

Intermittent Fever 286 

Intertrigo 286 

Intestinal Catarrh 287 

Intestinal Obstruction 287 

Intussusception 287 

Iodism 296 

Iritis 294 

Irritability 297 

Itch 287 

Itching 297 

Jaundice 297 

Keratitis 299 

Kidnev Diseases 300 

King's"' Evil 300 

Knee-jerk 300 

Labor 301 

Lactation (Excessive.) 319 

Laryngismus Stridulus 302 

Laryngitis 303 

Lead Colic 320 

Lead-poisoning... 305 

Lentigo... 320 

Leprosy 4 307 

Leucocythsemia 308 

Leucoderma 320 

Leucorrhcea 616, 311 

Lice 313 

Lichen 314 

Lipoma 319 

Lockjaw 319 

Locomotor Ataxia 315 

Lumbago 318 

Lupus 318 

Lymphadenoma 310 

Malarial Fevers 320 

Mania 332 

Mania, a potu 354 

Marasmus 333 

Mastitis 332 

Masturbation 354 

Measles 333 

Melancholia 336 

Meniere's Disease 357 

Meningitis , 337 

Menorrhagia 350 

Metritis 620 



XI V. 



GENERAL INDEX. 



Metrorrhagia 350 

Migraine 351 

Milium 357 

Milk-leg 357 

Miscarriage » 357 

Mitral Disease 351 

Moles 357 

Morbus Coxarius 358 

Morning Sickness 351 

Mother's Mark 357 

Mumps 352 

Muscular Rheumatism 358 

Myalgia 354 

Myelitis 343 

Nsevus 359 

Nausea 364 

Necrosis 360 

Nephritis 360 

Nettlerash 360 

Neuralgia 360 

Neurasthenia 366 

Neuritis 364 

Nightmare 365 

Night Screaming 365 

Nipple (Sore) 363 

Nymphomania 363 

Obesity 366 

(Edema 367 

(Esophageal Obstruction 379 

Onanism 376 

Onychia Maligna 367 

Opacities in Eye 377 

Ophthalmia 368 

Opium Habit 369 

Orchitis 371 

Ostitis 392 

Otalgia 374 

Otitis 373 

Overwork 378 

Oxaluria. 374 

Oxyuris- Vermicularis 376 

Ozena 375 

Painter's Colic 320 

Palpitation 380 

Paralysis 383 

Paralysis Agitans 473 

Paraphimosis 468 

Paraplegia 386 



Paresis 383 

Paronychia 199 

Parotitis 352 

Pediculi 387 

Pemphigus 387 



.PAGE. 

Pericarditis 388 

Periostitis 392 

Peritonitis 394 

Pertussis 400 

Phagedena 402 

Pharyngitis 403 

Phimosis 468 

Phlegmasia Alba Dolens 404 

Phthisis 406 

Phthisis (Fibroid) 431 

Pica and Malacia 472 

Piles 242 

Pityriasis 164 

Pleurisy 433 

Pneumonia (Lobar.) 440 

Pneumonia (Lobular.) 452 

Podagra 220 

Poisoning 632 

Pollution 170 

Polyphagia 473 

Polyuria 146 

Posterior Spinal Sclerosis 315 

Priapism 455 

Prickly Heat 456 

Prostatitis 456 

Prostatorrhcea 458 

Prurigo 459 

Pruritis 460 

Psoriasis 461 

Pterygium 470 

Ptyalism 493 

Puerperal Fever 463 

Purpura 465 

Pyaemia 466 

Pyelitis 470 

Pyonephrosis 470 

Pyrosis 467 

Quinsy 567 

Rabies 274 

Rachitis 475 

Ranula 486 

Rashes (Medicinal) 489 

Relapsing Fever 490 

Relaxed Uvula 488 

Remittent Fever 329 

Renal Calculi 92 

Restlessness 489 

Retention of Urine 486 

Rheumatism 478 

Rheumatism (Chronic Articular) 483 

Rheumatoid Arthritis 485 

Ringworm 565 

Roseola 488 



CiENEKAL index. 



XV. 



PAGE. 

Rubeola 333 

St. Vitus Dance 120 

Salivation 493 

Salt Rheum 165 

Satyriasis 494 

Scabies 494 

Scalds 87 

Scarlatina 495 

Sciatica 361 

Scorbutus 507 

Sclerosis of Brain 501 

Sclerosis, Cerebro-spinal 502 

Scrofula 504 

Scurvy 507 

Sea Sickness 508 

Seminal Emissions 169 

Septicaemia * 510 

Shingles •___ 246 

Shock 633,539 

Sick Headache 235 

Singultus 247 

Sleeplessness 284 

Small Pox 594 

Sneezing 537 

Somnambulism 537 

Sore-feet 537 

Sores 585 

Spermatorrhoea 511 

Spina Bifida 515 

Spinal Irritation 536 

Sprains 634, 518 

St. Anthony's Fire 181 

Stenosis of (Esophagus 379 

Stings 538 

St. Job's Disease 542 

Strangury 514 

Stricture 520 

Struma 504 

Stye (See Hordeolum.) 514 

Sudamina 539 

Summer Complaint 116 

SunStroke 255 

Suppression of Urine 540 

Sweating 190 

Syncope 199 

Synovitis 541 

Syphilis 542 



Tape- worms 

Tetanus 

Tic Douloureux 

Tinea 

Tinnitus Aurium 

Thread Worm 

Thrush 

Tongue-tie 

Tonsilitis 

Tooth ache 

Torticollis 

Trachoma 

Trichinosis .._ 

Trismus 

Tuberculosis v ' Acute Miliary.) _. 

Tympanites 

Typhoid Fever 

Typhus Fever 

Ulcers and Sores 

Ursemia 

Urethritis 

Urticaria 

Vaccination 

Vaginismus 

Vaginitis 

Valvular Diseases 

Varicella 

Varicocele 

Varicose Veins 

Variola 

Varoiloid 

Vertigo 

Vitiligo 

Vomiting 

Vulvitis 

Wakefulness 

Warts 

Water Brash 

Wens 

Whites 311 

Whitlow 

Whooping Cough 

Worms 376. 

Wounds (poisoned) 

Wrist-drop 

Wry-neck 

Yellow Fever 



PAGE. 

560 
562 
360 
564 
566 
376 
564 
572 
567 
569 
354 
572 
571 
562 
432 
570 
572 
583 
585 
586 
215 
587 
596 
588 
618 
596 
593 
590 
590 
594 
595 
590 
320 
592 
589 
284 
607 
467 
141 
616 
199 
400 
560 
632 
305 
354 
60S 



CHAPTEE I. 
THE EXAMINATION OF PATIENTS. 



To elicit the facts of a case by careful examination is the 
first requisite for diagnosis. There are two methods of exami- 
nation — the synthetical and the analytical. The synthetical 
method is the more scientific, but is too full, and calls for too 
much labor, to meet the requirements of ordinary professional life. 
It is the best where the symptoms are obscure and ill defined. 
It consists in getting the family history and the history anteced- 
ent to the present disease, before the present condition is ex- 
plored. 

In the analytical method the present condition is first 
ascertained. 

Da Costa uses the following plan of examination: 1. Date 
of examination. 2. Name. 3. Age. 4. Color. 5. Place of 
Birth. 6. Present abode. 7. Occupation. 8. In female, whether 
married or not, number of children, and date of last confinement. 

History — I. History antecedent to present disease: (1) 
Constitution and general health. (2) Hereditary predisposition 
(family history.) (3) Previous diseases or injuries. (4) 
Habits and mode of life. (5) Hygenic influences to which ex- 
posed. 

II. History of present disease: 1 Its supposed exciting- 
cause. 2 Date of seizure. 3 Mode of invasion. 4 Subsequent 
symptoms in order of succession. 5 Previous treatment. 

Present Condition of Patient. I. General symptoms: 1. 
Position, in bed — mode of lying — out of bed — movements. 2. 
Aspect, of body — of countenance. 3. Skin. 4. Pulse. 5. Tern- 



18 A COMPENDIUM OF PRACTICAL MEDICINE. 

perature. 6. Respiration. 7. Tongue. 8. Appetite, thirst, and 
condition of bowels. 9. General state of urinary secretion. 10. 
Sensations of the patient as to pain, etc. 

II. Examination of special regions. Diagnosis. Treat- 
ment. 

Position of the Body. If the patient is in bed, note how 
he lies; if out of bed, how he walks. If a healthy person be 
suddenly confined to his bed, the inference is that he will have 
an acute and severe disease. If the patient lies fixed upon 
one side, it shows, as a rule that the action of the lung of this 
side is impaired. The patient may be in bed but unable to 
lie down on account of distress in breathing. This dyspnoea 
is encountered especially in diseases of the heart, or where fluid 
is effused into the air cells or into both pleural cavities. 

In some diseases of the brain the gait is staggering. In 
one-sided palsy the movements are uncertain. 

General Aspect. — Expression of Countenance. The eye 
notices whether the body is bulky or wasted. If the bulky 
aspect is due to air in the tissues, they crepitate under the 
finger; if too fluid, the skin j^its under pressure. 

Emaciation is a more frequent symptom than augmentation. 
It may take place rapidly or gradually. Among the counte- 
nances most frequently met with is that of apathy and stupor. 
The eye is dull and listless; the face pale or flushed with fever. 
This look is common in fevers of a low type and is combined 
with dark material on the lips, gums and teeth. 

Unnatural fulness and congestion of the features are some- 
times observed in enlargements of the heart, and oftener still in 
.habitual drunkards. 

The same aspect is seen in apoplexy and in typhus fever. 
A pinched expression is found when there is intense anxiety or 
pain. The Hippocratic countenance denotes the moribund state. 
It is characterized by marked pallor with more or less lividity, 
pinching of the nostrils, sinking of the eyes, hollowness of the 
temples, coldness and transparency of the ears, dropping of the 
lower jaw. 

The face of shock, with its great pallor, its anxious or 
frightened look, is seen after severe injuries and operations. 



EXAMINATION OF PATIENT. 19 

A dusky flush on the face, if associated with rapid breath- 
ing, is almost a certain indication of inflammation of the lung. 

Pufhness. of the eyelids in a pallid person is very apt to be 
expressive of Bright' s disease. 

There is the straw-colored, anaemic hue of malignant dis- 
ease; the jaundice, melancholy look of an l^atic affection- 
Skin. — Coldness of the skin indicates a weakened capillary 
circulation. Protracted coldness, whether attended with dryness 
or with clamminess, is of evil augury. The skin is pale when- 
ever the blood is poor and watery. In wasting and prostrating 
ailments the skin feels very relaxed and soft. The skin may be 
dry, moist, or profusely wet and sodden. 

In most fevers with high temperature the skin is hot. Now, 
if we make the patient's skin moist, we promote his comfort and 
well-being. Small, often -repeated doses of tincture of aconite 
or tartar emetic will induce perspiration. 

In many cases of diabetes and Bright's disease, it is very 
difficult to make the very dry skin perspire. 

The two chief causes of sweating are weakness, and a fall 
in a febrile temperature, two causes often combined in the same 
person in exhausting febrile disease, as in phthisis. 

In exhausting diseases, sleep may produce sweating. Pro- 
fuse sweating occurs during convalescence from scarlet fever. 

With the exception of rheumatic fever, profuse sweating at 
the commencement of an acute febrile disease, when the temper- 
ature remains high, indicates great weakness. Duskiness of the 
face, ears and under the nails shows weakened heart action. 

Pulse. — The pulse is an accurate index of the condition of 
the heart, and is therefore the most valuable guide in disease. 

The importance of the pulse is manifest when we consider 
that disease kills by arresting the heart, Whilst the heart beats 
there is life and hope. In many instances, the pulse gives the 
first signs of danger, as in the case of pneumonia, in which dis- 
ease so long as the pulse continues good we have fair hopes of 
our patient. In other instances the nervous system first gives 
way, as shown by sleeplessness and delirium, and this depresses 
and Aveakens the heart. 



20 A COMPENDIUM OF PRACTICAL MEDICINE. 

In any case it is the ultimate effect of the disease on the 
heart that destroys life. 

The pulse -beats may be frequent or infrequent, slow or 
quick; small or large; compressible or incompressible; regular 
or irregular; or intermittent. 

By the frequency of the pulse we mean the number of beats- 
in a given time. 

In a quick pulse each beat occupies less than the usual 
time, that is, each wave is of short duration relatively to the 
pause between the waves. 

When the volume of the pulse is greater than usual, it is- 
said to be large; or the volume may be less than usual, when it 
is said to be small. 

When the fingers can easily stop the pulse it is said to be 
compressible; when on the other hand, it can be arrested only 
with difficulty or n,ot at all, the pulse is said to be incompressible^ 

In an irregular pulse, succeeding beats differ in length, force 
and character. 

In an intermittent pulse a beat is from time to time lost. 

The frequency of the healthy pulse varies; thus, in some 
persons the normal pulse is 100', in others as low as 50 a min- 
ute. Five conditions produce a frequent pulse: fever, debility T , 
excitement, hysteria, and cardiac disease. 

In fevers the pulse is generally accelerated in proportion to 
the elevation of temperature, more in children than in adults. 

When a pulse is more frequent than the temperature will 
explain, it indicates cardiac weakness. In all febrile diseases, a 
pulse in adults over 120 is serious and indicates cardiac weak- 
ness; a pulse of 130 or 140 indicates great danger; and with a 
pulse at 160 the patient almost always dies. 

In rheumatic fever a pulse of 120 indicates great danger. 
In such a case, the temperature is 104° to 105° F., the patient 
is prostrate, the tongue dry, and sordes collect on the lips ; a 
case like this often ends fatally, and when the pulse rises above 
120, the patient will pretty surely die. 

If pericarditis, a complication of rheumatism, causes the 
frequent pulse, it is of less import. 



EXAMINATION OF PATIENT. 21 

An irregular pulse from mitral disease may be very frequent, 
120, 130, or more, without indicating extreme danger. 

Sometimes in typhoid fever, though the temperature is high, 
the pulse remains normal throughout the attack, and this shows 
absence of cardiac weakness. 

In chronic diseases a frequent pulse very generally indicates 
cardiac weakness. A weakened heart diminishes arterial tension, 
and the pulse becomes soft and compressible. If the heart be- 
comes still more weak, the pulse becomes small as well as quick, 
and compressible. Smallness of the pulse, therefore, indicates 
still greater weakness. When the pulse is very small it is said 
to be thready. The more frequent, the more compressible, the 
smaller the pulse, the greater the cardiac weakness, and the 
greater the need of cardiac stimulants. 

The general condition of the patient may be good, but the 
pulse is frequent, small, compressible and quick, and indicates 
danger. The pulse in some persons is easily made frequent with- 
out this frequency indicating any danger. In some persons in 
perfect health we find a very small and compressible pulse. So 
long as the pulse remains good, we feel that our patient is com- 
paratively safe. 

An infrequent pulse occurs in some cases of blood-poison- 
ing, as in jaundice, uraemia, and in these cases, the tempera- 
ture is often subnormal. An infrequent pulse is met with, 
sometimes in fatty degeneration of the heart, and in aortic ob- 
struction, in irritation of the vagus or its root, as in meningitis, 
oerebral tumors or compression. 

The size of the pulse varies in disease. It is often large at 
the commencement of fever. The pulse is small in inanition, 
owing to the small quantity of blood. It is small, too, in mitral 
obstruction, and in mitral regurgitant disease, and in aortic 
stenosis; also with cardiac debility. 

In an intermittent pulse, an occasional beat is missed, the 
rhythm being otherwise regular. An intermittent pulse is very 
different from an irregular pulse. Some persons have a life-long 
intermittent pulse, but ordinarily it does not occur till after 
middle age. It maybe persistent or occasional; and when occa- 
sional only it is often due to an idiosyncrasy, and is caused by 



22 A COMPENDIUM OF PRACTICAL MEDICINE. 

some article of food, as tea, smoking or indigestion. By the 
intermission some persons are made very uncomfortable and 
nervous, and get the sensation as if the heart stopped or rolled 
over. In most cases an intermittent heart is of no significance. 

An irregular pulse is of far more serious significance than 
an intermittent. The pulse is irregular, both in force and rhythm, 
succeeding beats differing in length, force and character. It is 
generally due to mitral, and rarely occurs in other forms of heart 
disease, though sometimes met with in great cardiac prostration, 
as in an acute febrile illness, a few hours before death. It occurs, 
too, in fatty degeneration of the heart, and in the first and sec- 
ond stage of meningitis. The irregular pulse indicates the need 
of digitalis. Whilst an irregular pulse almost always indicates 
mitral disease, yet a perfectly regular pulse may accompany 
either mitral obstruction or regurgitation. Although irregu- 
larity from mitral disease is rare in children, yet Ringer has seen 
aconite, in half -drop doses repeated hourly several times pro- 
duce marked irregularity of the pulse. An irregular pulse is 
common in children with tubercular meningitis, and it is a diag- 
nostic guide. In some cases of cerebral disease, with Cheyne- 
Stokes breathing, the pulse is irregular. 

An irregular pulse may be due to much smoking, to 
venereal excess, and to tea drinking. The condition of the 
blood-vessels influences the pulse. 

Through the action of the vaso- motor nerves on the mus- 
cular coat of the arteries, the small blood-vessels undergo relaxa- 
tion or contraction. When the vessels are relaxed the blood 
passes easily from the arteries to the veins, hence arterial tension 
is slight, and the pulse is soft, large and compressible. This 
pulse is met with in the early stage of some fevers. 

Arterial relaxation, or low tension, produces a dicrotic pulse. 
In this pulse one of the normal secondary waves of oscillation 
becomes greatly exaggerated, so that it can be easily felt by the 
finger. Indeed, it may be so distinct that an inexperienced per- 
son may mistake it for the primary wave. Ringer has known a 
nurse to make this mistake, and thus to double the number of 
true pulsations. A dicrotic pulse always indicates marked 
arterial relaxation, and often coincides with cardiac weakness 



EXAMINATION OF PATIENT. 23 

and is frequently met with in typhoid fever. When the vessels 
are contracted the blood escapes with greater difficulty from the 
arteries into the veins, and we have the pulse of high arterial 
tension. In this case the artery is hard and cord-like; it can be 
rolled under the finger and is easily traced in its course up the 
fore -arm. With the vessels in this condition, the pulsation is 
often so slight that it might readily be mistaken for a weak pulse ; 
but its incompressibility prevents this error. In addition to be- 
ing small, the pulse is slow and hard. 

The following conditions give rise to high arterial tension: 
1. Degeneration of vessels. 2. Bright's disease, especially the 
contracted kidney. 3. Gout, jaundice, lead- poisoning, ergot and 
gallic acid. 4. Affections of the nervous system. 5. The rigor 
of fevers. 

High arterial tension and hypertrophy of the heart, asso- 
ciated with an increased quantity of urine containing a small 
quantity of albumen, enables us to diagnose the contracted form 
of Bright' s disease. 

During the rigor or chill of fevers the arteries contract, and 
produce a pulse of high arterial tension, which is frequent, small, 
hard, incompressible and slow. When the chill is over and the 
fever established, the arteries relax, and the pulse is large, full, 
and not easily compressed — bounding, as it is called. 

In well-marked aortic regurgitation, the pulse is often char- 
acteristic. It is a pulse of extreme low tension. If the radial 
artery is at all visible with the limb dependent, this visibility 
becomes much more marked on raising the arm. In advanced 
aortic regurgitation, the pulse gives to the finger a sharp, quick 
stroke. This is the diagnostic quality of the pulse. The pulse 
feels as if a small ball or shot was puffed under the finger, and 
is called the shotty pulse. Visible pulsation of the whole 
length of the carotid to the lobe of the ear, and of the temperal 
and perhaps of the facial artery, is far more frequently due to 
aortic regurgitation than to high arterial tension, or to low ar- 
terial tension, or to degeneration of the arteries. 

Aortic regurgitation is especially a disease of middle or 
advanced life, being due to age and strain. In arterial degen- 
eration the arteries become elongated and tortuous, easily visible 



24 A COMPENDIUM OF PRACTICAL MEDICINE. 

in the brachial just above the elbow. The arteries feel hard and 
cordy, and sometimes calcareous jDlates can be felt. 

The pulse of aortic obstruction is slow, generally small, in- 
frequent, and often hard. In marked mitral obstructive disease, 
the pulse, when not irregular, is small and compressible. 

Aneurism of the aorta often delays the pulse, and it may 
do this on one side more than on the other, or on one side alone. 
In aneurism of the aorta influencing the arteries of one arm 
only, the artery on this side can be felt to fill more slowly 
(Ringer). 

As the full pulse is not always strong, neither is the small 
pulse always weak (DaCosta). 

Such are the meanings attached to the various characters of 
the pulse. The appreciation of these different kinds of pulses 
requires considerable practice. 

Tongue. — The tongue is a mirror which reflects the condition 
of the digestive functions, the complexion of the nervous power 
and of the blood, and the state of the secretions. 

We examine the tongue in regard to its movements, its 
volume, its dryness or its humidity, its color and its coating. 

The movements of the tongue are impeded and tremulous 
in exhausted states of the system. It is protruded slowly and 
with difficulty in fevers of a low type. In hemiplegia one side 
is crippled, and the tongue turns toward one of the corners of 
the mouth. 

The volume of the tongue is changed by its own diseases 
Yet a broad and flabby tongue, on the sides of which the teeth 
leave their marks, is sometimes found in chronic ailments of the 
digestive organs, and as a result of the action of mercury and of 
certain poisons. It is observed in some diseases of the brain 
and heart, and in typhus and scurvy. 

Dryness of the tongue indicates deficient salivary secretion. 
The tongue is dry in acute visceral inflammations, in the exan- 
themata, and in typhoid fever. If the tongue be very dry, of a 
dark color, glazy, or furred or fissured, it denotes depraved 
blood. A fissured tongue may occur in chronic affections of the 
liver and intestines, and in some persons it is congenital. The 
tongue may become dry from persistent openness of the mouth, 



EXAMINATION OF PATIENT. 25 

as during sleep, or from coma, and has no significance. Among 
chronic diseases the tongue is most apt to be found dry in 
diabetes. 

A dry tongue is never a favorable sign. It is present in 
about fifty per cent, of fatal cases; more than any other it fore- 
tells death. A moist or humid tongue is a favorable sign. 

The dryness first invades the tip and extends up the centre. 
A dry tongue generally indicates nervous depression, often 
shown by low muttering delirium. This depression is often due 
to want of sleep. Narcotics, therefore, like chloral, bromide of 
potassium, or opium, by inducing sleep, soothe and strengthen 
the nervous system, and indirectly moisten the tongue. 

The dry tongue is often an indication for alcoholic stimu- 
lants. The two chief uses of alcohol are to assist digestion 
and to sustain the nervous system. Now sleep is the best 
restorative; hence fever patients who sleep well do not as a rule 
require stimulants. 

But, if in spite of sleep the tongue remains dry and delirium 
persists, then alcohol is indicated. Usually a patient with a dry 
tongue has a frequent, quick and compressible pulse calling for 
alcoholic stimulation. 

If the alcohol makes the tongue drier and more coated, it 
is contraindicated. In the aged, the tongue often becomes dry 
without fever. 

The color of the tongue is a useful sign. A broad, pale, 
flabby teeth -indented tongue indicates anaemia with a relaxed 
condition of the tissues. This tongue is met with in chlorosis, 
and in some chronic diseases, as Bright's, and always signifies 
the need of iron. 

In diabetes the tongue becomes smooth, glazed, shiny, 
beefy looking, abnormally clean and often very dry. If the 
tongue be red, too clean, too smooth or slightly furred, it points 
to an irritable state of the stomach, to dyspepsia. It is met with 
in drunkards and in phthisis when the intestines are ulcerated, 
and in tubercular peritonitis. One minim of Fowler's solution 
given before meals will improve this tongue. The tongue is 
exceedingly red in scarlet fever, and is known as the "straw- 



26 A COMPENDIUM OF PRACTICAL MEDICINE. 

berry tongue.'" A red, smooth tongue is a sign of failing 
nutrition. 

The " nervous tongue " is very slightly coated and covered 
with a slight froth, and is met with in persons of nervous tem- 
perament, and in cases where the nervous system has been de- 
pressed by overwork, and worry. 

The coating of the tongue is hardly discernible in health; 
but in disease the epithelium accumulates, and the tongue has a 
loaded, whitish appearance due to an excess of white epithelium. 
The coat is apt to be yellowish in disturbances of the liver, and 
of brown or very dark hue when the blood is contaminated. 

There are many healthy persons who wake up every morn- 
ing with their tongues covered, more especially at the back, 
with a heavy coating, which wears off after a meal. The tongue 
may be bare of its epithelium in certain instances of scurvy, 
chronic diarrhoea, dysentery, malaria, scarlet fever and typhoid 
fever. 

Local causes often coat the tongue. Enlarged tonsils often 
coat the back of the tongue. Decayed teeth often fur a portion 
of the tongue. Excessive smoking almost always coats the 
tongue. A coated tongue very frequently indicates derangement 
of the stomach, bowels or liver. 

If the patient be constipated, and the stools light colored 
and the tongue coated, give calomel with extract of belladonna, 
or hyoscyamus. 

If the bowels are freely open, and the tongue still coated, 
give in addition to the above, five drops each of tincture of nux 
vomica and dilute nitric acid thrice daily. 

After an acute illness like typhoid fever, the tongue some- 
times parts with its coating in flakes. 

The manifestations afforded by the tongue which are indi- 
cative of danger, are tremulous action, dryness, a livid color, a 
very red, shining or raw aspect, and a heavy coating of a dark 
or black hue (Ringer and DaCosta). 

Sensations of Patients. — Sick persons have many disagreeable 
feelings. They complain of chills, heat, languor, restlessness 
and of uneasiness; but their most constant complaint is of pain. 

Pain may be dull or gnawing, acute and lancinating, per- 



EXAMINATION OF PATIENT. 27 

manent or remitting. A dull pain is generally persistent. It is 
present in congestions, in chronic inflammations, and in acute 
inflammations of the parenchymatous viscera, and of mucous 
membranes. 

Acute pain is usually remittent and not so fixed to one spot. 
It is present in spasmodic affections, in neuralgia, and, with ex- 
tremely sharp and lancinating pangs, in malignant disease. 

Pain varies much in intensity. It is sometimes so extreme 
as to cause death. We have to judge of its severity partly on 
the testimony of the sufferer. 

The seat to which the pain is referred is far from being 
always the seat of the disease. A calculus in the bladder may 
produce dragging sensations extending down the thighs; inflam- 
mation of the hip joint gives rise to pain in the knee; disorders 
of the liver occasion pain in the right shoulder. The pain is 
either transmitted in the course of a nerve involved, or is sym- 
pathetic. 

Pain in diseases of the periosteum and bones is mostly 
boring and constant; in the serous membranes, sharp; in the 
mucous membranes, dull; and in the skin, burning or itching. 

Pain produced by pressure is called tenderness (DaCosta). 

Temperature. — The clinical thermometer may be put under 
the tongue, or in the axilla, or in the rectum. The rectal tem- 
perature is about one degree higher than the mouth or axillary 
temperature. The temperature in health varies in the 24 hours. 
During the day, between 9 a. m. and 4 p. m., the healthy tem- 
perature is usually about 99° F., or it may rise to 99.5° F. Any 
rise above 99.5° F. constitutes fever. At midnight the temper- 
ature is about 97° F., or even 96° F. The temperature should 
be taken in the morning about 7, and in the evening at the same 
hour. If only a single observation be taken, it is best done in 
the evening. 

While any elevation of temperature above 99.5° F. in- 
dicates disease, it need hardly be pointed out that a normal 
temperature does not necessarily indicate health. Many diseases, 
both acute and chronic, during their whole courses are unat- 
tended with fever. As a rule, the morning temperature is Lower 
than the evening. In rare cases the reverse happens. In some 



28 A COMPENDIUM OF PRACTICAL MEDICINE. 

chronic cases, as phthisis, and snb-acnte rheumatism, the fever 
may last only a few hours during the day. 

In ordinary cases, the pulse and temperature rise synchron- 
ously, and every degree above 98° F. corresjDonds with an 
increase of ten beats of the pulse. When the temperature ex- 
ceeds 106° F., the patient may be looked upon as in danger, 
except the rise be due to malarial fever. Under these circum- 
stances, it is rapid, occurring in a jDerson who yesterday, or but 
a few hours before, was healthy. In typhoid fever a tempera- 
ture of 105° F. is proof of grave disease. In pneumonia, a 
temperature above 104° F. is a symptom of very serious 
seizure. 

Stability of temperature from morning to evening is a good 
sign; the temperature remaining the same from evening till 
morning is a sign that the patient is getting worse. If, after the 
defervescence, the thermometer again indicates a decided rise, it 
shows a return of the malady or complication. 

Specific forms of febrile diseases have their characteristic 
temperature records. In measles, for instance, the temperature 
rises toward the breaking out of the rash, reaches its height 
with the period of eruption, and in twenty -four hours succeed- 
ing it falls rapidly. In scarlet fever the thermometer marks 105° 
F. or more at the beginning, and the fever gradually sub- 
sides. Typhoid fever has its characteristic record; so have the 
malarial fevers theirs. The temperature of tetanus rises to great 
heights before death. 

A temperature above 107° F. is almost certain to be the 
forerunner of a fatal issue. But recovery may take place. Da- 
Costa reports a case of cerebral rheumatism, in which the ther- 
mometer marked 110° F., yet the ]3atient got well. 

In a case of injury to the spine after a fall, reported by 
Teale, the young lady lived, though the temperature reached 
above 122° F., and ranged for days between 112° F. and 
114° F. A case of hysteria and intercostal neuralgia has 
been reported, in which the thermometer registered 117° F., 
and the patient recovered. The temperature may, also, be very 
high for a short time, from emotion. In children the tempera- 
ture is relatively higher than in adults with the same disturbance. 



EXAMINATION OF PATIENT. 29 

The thermometer assists us in diagnosis. We should search 
carefully to discover the cause of the fever. The fever may be 
due only to the acute contagious diseases, acute inflammation of 
some organ, rheumatism, gout, or to the diseases causing chronic 
fever. In the acute specific diseases, fever and sore throat would 
point to scarlet fever; severe backache, headache and sore throat 
to small-pox; coryza, with cough, to measles. Severe fever, 
ushered in by a severe rigor, with severe headache, and pain in 
the limbs, would suggest typhus; whilst dull, frontal headache, 
with diarrhoea, would strongly point to typhoid fever. If the 
second day passes without the occurrence of a rash, the case in 
all probability, is not one of scarlet fever; for the rash of this 
disease appears on the first or second day. If the third day 
passes without a rash, the case is not small -pox, for this rash 
usually appears punctually on the third day. If the fourth day 
passes without a rash, the case is not one of measles. If the 
fifth day passes without a rash, the case is not typhus, for the 
rash punctually appears on this day. 

The diagnostic value of temperature is shown in the follow- 
ing : A patient is suddenly seized with severe pain on the side 
of the chest. The pain, shooting or stabbing in character, is in- 
tensified on coughing or deep breathing. This is the character- 
istic pain of pleurisy and of pleurodynia; one an inflammatory 
disease, the other a non- inflammatory disease — which is it ( 
Before the physical signs develop nothing but the thermometer 
will solve the difficulty. If the attack be pleurisy, an inflamma- 
tory disease, there is fever, whereas if the attack be pleurodynia, 
a non-inflammatory disease, fever is absent. 

The temperature rises rapidly in most inflammations, in 
typhus, scarlet fever, measles, erysipelas, etc. In some diseases 
the temperature rises more gradually. This happens in most 
cases of tuberculosis and in almost all cases of typhoid fe\ ( r. 
and sometimes in rheumatism and pleurisy. 

The duration of the fever often aids in the diagnosis. In 
most acute diseases the fever usually passes away by the fifth or 
tenth day. In some cases of typhoid fever the symptoms are not 
sufficiently marked to enable the doctor to decide whether the 
case is one of typhoid fever, tuberculosis or phthisis. If the 



30 A COMPENDIUM OF PRACTICAL MEDICINE. 

fever goes on beyond thirty days then probably the patient 
suffers from consumption, and each additional day of fever 
strengthens this conclusion. 

A sudden and considerable fall of temperature, if not due 
to the natural termination of the illness, means sudden collapse. 
It is oftenest met with in typhoid fever, and it means hemorrhage 
into the bowels, or rjerforation of the intestines. Each week in 
typhoid fever a great morning fall often occurs. A fall equal to 
that due to hemorrhage or perforation, may occur at any time, 
but the fall with these accidents is more persistent, and is always 
accompanied by the symptoms of collapse. 

Chronic Fever. — In some diseases fever may persist for 
weeks or months, and by its very duration help the diagnosis. 
In most cases, when the fever has lasted only a short time, the 
other symptoms reveal the nature of the disease; but frequently 
the nature of the malady remains for a long time obscure, and 
then the fever aids in the diagnosis. 

Since most acute illnesses come to an end, in the great major- 
ity of cases, before the thirtieth day, we may take that as the 
limit of acute fever. 

Chronic fever occurs in phthisis, abscess, syphilis, ague, 
rheumatism, in most cases of leucocythemia, pernicious anaemia, 
and chronic pyaemia. The temperature is an index of the activ- 
ity of the disease. If the fever be high the disease is active. 
In some very chronic cases of phthisis the disease advances too 
slowly to elevate the temperature. 

By the aid of the thermometer we can often diagnose 
phthisis, before we can detect any physical signs, and at a period 
when symptoms themselves are insufficient to justify a grave 
diagnosis. A patient suffers from chronic fever. What is the 
cause of it? So far as we at present know chronic fever occurs 
only in tuberculosis, catarrhal pneumonia, large abscesses, rheu- 
matism, ague, occasionally in syphilis, in some cases of leucocy- 
thaemia, in lymphadenoma, and in pernicious anaemia and chronic 
pyaemia. The discrimination of these diseases is rarely difficult. 

The following cases illustrate the usefulness of the ther- 
mometer in doubtful cases of phthisis: 



EXAMINATION OF PATIENT. 31 

A patient is taken rather suddenly ill. His face is flushed, 
eyes bright, pulse quick. The temperature is very high. There 
is no headache, no delirium, no diarrhoea. So weak is he that 
he stays in bed. He continues in this state for a month or five 
weeks when distinct physical signs at the apices of the lungs ap- 
pear, accompanied by cough and expectoration, and possibly 
slight haemoptysis. 

A woman between 30 and 35 years of age, fails slightly in 
health, complains of slight weakness, is soon tired, but is never 
ill enough to be confined to bed. Her appetite is bad. There 
is a trifling cough with expectoration slightly streaked with 
blood once or twice. There may be a family predisjDosition to 
phthisis. Xo physical signs are apparent; yet the temperature, 
rising nightly to 101 or 102° F., declares the true nature of 
the disease, (Einger and Da Costa). 



CHAPTER II. 

DISEASES IN GENERAL, 



ABORTION. 

T. Gaillard Thomas says, that the uterus is the organ 
which divides one sex from the other, that this organ has three 
entirely distinct and different periods of existence, that from 
birth to the age of thirteen, or puberty, it is undeveloped and 
unimportant, and that from thirteen to fifty its career is one of 
intense activity, and has a marked influence upon the whole being 
of a woman, that from the age of about fifty, to the close of life 
it sinks into insignificance again, and becomes an atrophied and 
unimportant organ — of no use whatever, that impregnation and 
conception are two entirely different things, that the ova may 
become impregnated twelve times a year, and yet conception may 
not result; that conception is the fixation of the impregnated ovum; 
that up to two and a half months there is no placenta, so far as 
abortion is concerned, that from the third month the placenta is 
the all -important element as regards abortion; that abortion is to 
be defined as the premature casting off of the product of concep- 
tion before the end of the fourth month; that between the end of 
the fourth month and the end of the sixth month it is called mis- 
carriage, and that between the end of the sixth month and the 
end of the ninth month it is called premature labor. 

When abortion occurs, one of four things may take place: 
First, the entire contents of the uterus — the decidua vera, the 
decidua reflexa, the amnion, the chorion, and the foetus may be 
expelled. Second, the foetus may be expelled with the amnion 



ABOBTION. 33 

and chorion, wliile the decidua vera and reflexa are left in the 
nterns. These membranes will come away later in the lochial 
discharge. Third, the foetus alone may be expelled. This is a 
complicated case. In this case the uterus must be emptied of 
its contents or the patient will have a violent chill and high 
fever, with all the signs of septicaemia. Fourth, the foetus and 
membranes may be expelled, and the placenta, when one is 
formed, left behind. Thus, we see that abortion does not always 
occur in the same way, and that the physician must treat each 
case according to its character. 

Causes. — 1. Carbonic- oxide gas inhaled by the mother is 
more certain to produce uterine contractions than ergot. The 
crowding together within confined quarters of pregnant women 
will cause a large number to abort, due to the poisoning of their 
blood by this gas. This gas, generated after death, produces 
uterine contraction, and post-mortem delivery of pregnant 
women. 2. The poisons in the blood produced by small-pox, 
scarlatina, measles and malaria. 3. Chorea, tetanus, and reflex 
influences, such as fright. 4. Certain drugs, such as ergot, 
cotton -root, etc. 5. Anything which will kill the foetus will 
produce an abortion, such as a twist, or knot in the umbilical 
cord, syphilis, a kick or blow upon the abdomen. 6. Retroflex- 
ion of the uterus. In anteflexion of the uterus, sterility is com- 
mon, but endometritis and abortion are rare. 7. Uterine fibroids 
and other neoplasms, and laceration of the external os. 8. Some- 
times jars to the body from vomiting, coughing and straining, 
from railroad journeys, from violent exercise, from falls, and the 
like. A large proportion of abortions occur about the end of 
the third month. During an abortion, the attitude of the physi- 
cian, beyond the control of hemorrhage, should be an expectant 
one. In habitual abortion the most common causes are syphilis 
and retroflexion of the uterus. There are many women of nerv- 
ous temperament in whom the slightest cause is often sufficient 
to induce an abortion; while, in others, it is exceedingly difficult 
for them to get rid of the contents of the uterus before the nor- 
mal end of pregnancy. 

This is shown in attempts at criminal abortion. Lusk re- 
lates the case of a peasant who took his wife, while pregnant, 



34 A COMPENDIUM OF PRACTICAL MEDICINE. 

behind him on horseback and started on 2 with her at fnll gallop, 
with the view of causing her to miscarry. Having thus thor- 
oughly shaken her, he dropped her suddenly to the ground with- 
out slackening his speed. This brutal manoeuvre he repeated 
twice, without the least success. Thomas mentions cases of 
pregnant young women in Paris who attempted suicide by jump- 
ing into the Seine, and were rescued and went on to full term. 
Pregnant women, excited by an alarm of fire, have jumped from 
an upper window, breaking several bones, and have passed on to 
full term as though nothing had happened. 

Prognosis. — The prognosis is good, except in criminal cases. 

Dangers. — 1. Hemorrhage'. 2. Putrid intoxication from ab- 
sorption of the decomposing product of conception. 3. Septi- 
caemia and jDeritonitis. In this case the septic material is conveyed 
to the womb by the hand or instruments of the physician. 4. 
Surjpurative arthritis. 5. Cellulitis and abscess. 6. Embolism. 
This may cause hemiplegia. 7. Air in the veins. The air is 
usually introduced through a hollow instrument used in the 
uterus. 8. Tetanus. This comes from putrid infection. 

Symptoms. — There are three essential symptoms: 1. Hem- 
orrhage. 2. Pain. 3. Vomiting; this last may be absent. 

Treatment.— The treatment is divided into : 1. Prophylaxis 
in cases of habitual abortion. If the cause be syphilis, give the 
antisyphilitics. If the cause be displacements of the uterus, 
correct these. If the cause be nerve irritability, give the patient 
teaspoonful doses of the fluid extract of viburnum prunifolium 
three times daily, beginning two days before the menstrual date, 
and continuing for eight days, with the patient in bed. 2. Ar- 
rest of threatened abortion. Keep the patient quiet in bed and 
give the following: 

Jfc Potassii Bromidi gr. x. 

Chloral hydratis gr. vi. 

Morphinae sulphatis gr. \. — M. 

Sig. : One dose. 

Repeat if necessary. The chloral induces sleep, the bromide 
has a sedative effect upon the nervous system, and the morphine 
robs life of its cares. If the patient be bleeding freely, apply a 
tampon, and remove it in twenty-four hours. In the first two 



ABORTION. 35 

months little treatment besides rest in bed for a few days is re- 
quired. 3. The treatment of inevitable abortion. Get the 
woman through with the abortion as quickly as possible, and 
leave nothing in the uterus for bacteria to work on. Your 
hands, instruments, sponges, and tampon, if used, should all be 
aseptic. 

If the abortion is going on and the woman is losing large 
quantities of blood, the tampon is the best remedy. When in 
the third month the ovum is thrown off without rupture of the 
foetal membranes, the hemorrhage is rarely dangerous. The 
treatment is very simple — a carbolized douche morning and 
evening. When the sac raptures the hemorrhage is usually pro- 
fuse. The treatment indicated in this case is to check the hem- 
orrhage by a tampon, and afterwards empty the uterus by means 
of the finger or curette. Do not give opium to quiet pain. Do 
not give ergot unless the cervix is well dilated. A good tampon 
is made by soaking cotton wool in carbolized water, five per 
cent, solution, and after pressing out the excess of fluid, make 
into flat pieces, and pack well around the vaginal portion then 
over the os. A tampon should not remain over twelve hours in 
the vagina. In emergency a soft towel, handkerchief, strips of 
cotton cloth and a roller bandage may be used for a tampon. 
4. The treatment of neglected abort ion is to clean out the 
uterus with the finger or dull wire curette and use carbolized 
douche (5i-Oj). The temperature, if high will soon fall after 
the curettage and douche. 

Chances of error in connection with abortion. — 1. Could 
a woman have an abortion, say, at the end of the third month, 
and at the end of six months from that time be delivered of a 
fully -developed living child? Yes, and the explanation is, that 
one of a pair of twins has been cast off and the other has gone to 
full term. 2. A woman has an abortion and the feet us is cast off 
with all its membranes entire. In a month from the date of the 
abortion the woman suddenly dies in collapse. An examination 
shows that in addition to the foetus in the uterus there lias been 
an extra-uterine one, and the fatal result was due to rupture of 
the Fallopian tube. 3. A woman has an abortion and the foetus 
is cast off but not all the membranes. The next month the 



36 A COMPENDIUM OF PRACTICAL MEDICINE. 

patient does not menstruate. About the end of the ninth month, 
the uterus begins to contract, but instead of a living child being 
delivered, a bucketful of hydatids is cast off. These little cysts 
developed in the retained membranes. 4. The foetus is cast off 
with the lower portions of the fcetal shell, leaving the remainder 
of the shell still in the uterus. This may remain for months or 
years constituting " molar pregnancy." 

Artificial Production of Abortion. — Never induce an abortion 
without first having a consultation. 

Indications. — Whenever it is felt that the prolongation of 
pregnancy is going to destroy the life or intellect, or to perman- 
ently ruin the health of a patient, abortion should be brought on. 

The methods by which Abortion is brought on. 1. The first 
method is to introduce a metallic sound into the os- uteri, and 
push it forcibly through the fcetal shell. If there be a brutal 
and stupid method of producing abortion, it is certainly this. It 
is the one commonly practiced in criminal abortions. It will 
kill the foetus, but it may not come away and thereby produce 
putrefaction and septicaemia. This method should not be used. 
2. The second method is to take sponge tents, and introduce 
them into the os internum. This method should be avoided. 3. 
Certain drugs, such as ergot, savin, pennyroyal, viscum album, 
and the root of the cotton plant. No scientific j^hysician would 
ever think of placing any dependence upon them whatever. 4. 
The best method and the one which is sure and safe is as fol- 
lows: Anaesthetize the patient with ether, and place her in the 
Sims position. Fill the vagina with bichloride solution, (1 to 
2,000). Next you catch the cervix with a little tenaculum and 
dip it below the surface of the bichloride solution. With a 
divulsor you stretch the cervical canal until you can introduce 
your finger. You next introduce a glass plug as large as the 
finger into the cervix. You then pack the vagina with iodoform 
gauze and then aijply a tampon. This is all you have to do. 
The plug and the tampon may be left in position for thirty- six 
to forty- eight hours. 

You may have to stretch the os again and put in a larger 
plug. The plug should be an inch and a half in length with a 
shoulder which prevents its entrance into the uterine cavity. 



ABORTION ABSCESS. 37 

PRESCRIPTIONS FOR ABORTION. 

^ Tincturse opii, ITTxx-xxx. 

Sig. : Mix with three tablespoonfuls of boiled starch and in- 
ject into the rectum. — Parvin. 



I£ Misturse asafcetidse Sviij. 

Sig.: A tablespoonful several times daily. (In habitual 
abortion.) — Negri. 



$ Tincturse ferri chloridi Sss. 

Potassii chloratis 5j • 

Syrupi simplicis. Sj • 

Aquae menthse piperitse ad Siv. — M. 

Sig.: A dessertspoonful in a wineglassful of water after meals. 
(When due to fatty degeneration of the placenta.) — Strother. 

5 Auri et sodii chloridi gr. iv. 

Aquae destillatae Sj- — M. 

Sig.: Six drops in a tablespoonful of water three times 

daily after meals. (In habitual abortion.) — Martin. 

ABSCESS. 

A circumscribed collection of pus in any tissue is called an 
abscess. Pus in a preformed cavity is called empyema. An 
abscess is always the result of an inflammatory process. 

Varieties. — When an abscess forms rapidly it is called 
acute, hot, or phlegmonous, and its pus is living. When it is of 
slow formation, it is called chronic, cold, lymphatic or tubercu- 
lous, and its pus is dead. 

Symptoms. — We may have, 1. History of an injury. 2. 
Defective nutrition. 3. Rigor or chills. 4. Elevation of tem- 
perature. 5. Fluctuation. 6. The five cardinal symptoms of 
inflammation which are, redness, swelling, heat, pain and loss of 
function. If the abscess be acute or hot, the pus is thick and 
creamy, the walls of the cavity are tense, the surrounding tissues 
are indurated, and there is a tendency to burst at the point of 



38 A COMPENDIUM OF PRACTICAL MEDICINE. 

least resistance. If the abscess be chronic or cold, the pns is 
thin, serous and gelatinous, the walls are flabby, the surrounding 
tissues are not indurated. 

Causes. — The tendency of late is to regard all acute 
abscesses as due to a special micro-organism, the staphilococcus 
pyogenes aureus. Chronic abscess is due to the bacillus tuber- 
culosis. 

All varieties may start from injury. 

The origin of pus in an abscess is emigration of white cor- 
puscles, proliferation of connective tissue cells, granules of fat, 
and debris of inflamed tissue floating in serum. 

Varieties of Pus. — Pus when thick and creamy is known as 
" healthy " or laudable pus, or living pus; when thin and watery 
" puriform fluid " or dead pus; when blood-stained "sanious;" 
gummy pus in syphilis; and contagious pus in small-pox, gonor- 
rhoea and venereal ulcers. 

Diagnosis. — Abscess must be diagnosed from: 1. Hsemat- 
ocele. 2. Cyst. 3. Lipoma. 4. Aneurism, and 5. Malignant 
tumors. Hematocele has a rapid growth, evidence of an injury, 
and no change in the skin. The walls of a cyst are distended 
by fluid which distinctly outlines it. In fatty tumor or lipoma, 
the skin is unchanged and may be lifted up from tumor. In an- 
eurism there is a distinct expansile pulsation synchronous with 
the heart's action. Pressure on the artery above the aneurism 
diminishes its size, while pressure below increases its size. An 
aneurism has a rasping sound like sawing wood. The pain of 
aneurism is very characteristic — sharp and lancinating produced 
by pressure on nerve. 

Use a hypodermic syringe to make the diagnosis. The pain 
in acute abscess is at first dull and heavy and then throbbing. 
There is not much pain in a cold abscess. 

We speak of an abscess according to its situation, as mam- 
mary, lumbar, cerebral, perineal, post-pharyngeal, etc. 

Prognosis. — Depends, 1. On the size of the abscess. 2. On 
its character. 3. On the age of the patient. 4. Situation of 
the abscess. 5. Condition of the patient, and 6. On its cause. 

Treatment. — Never squeeze an abscess but drain it freely. 
An acute abscess should be opened in the most dependent part, 



ABSCESS. 39 

using a sharp bistoury for the purpose; press out gently the 
accumulated material, wash it with bichloride of mercury (1 to 
1,000), insert a drainage tube, and place upon the outside iodo- 
form gauze. We do not open a chronic abscess but aspirate it. 
Do not allow air to go in. A small amount of pus may be ab- 
sorbed. 

Constitutional Treatment. Give tonics, such as iron, qui- 
nine and strychnine together with good nutritious diet and 
plenty of fresh air. 

PRESCRIPTIONS FOR ABSCESS. 

J& Iodoformi oiij- 

Aetheris 3 vi. — M. 

Sig. : Inject three to five ounces after aspirating the abscess. 
(In cold or tubercular abscess.) — Mosetig Moorhof. 

Jfc Iodoformi oij. 

Glycerinse Siiss. — M. 

Sig.: Inject the abscess cavity, after evacuating the pus. (In 
cold or tubercular abscess). — Billroth. 

{& Calcii sulphidi gr. ij. 

Sacchari lactis gr. xx. — M. 

In chartulas xx. div. Sig.: Take one powder every hour or two. 

— Ringer. 

Jfc Emplastrum belladonna? 

Sig.: Apply to abscess to relieve pain. — Bartholow. 

|fc Potassii permanganatis 5j- 

Aquse destillatse Oj. — M. 

Sig.: Apply to correct the fetor of abscess. — Bartholow. 

J£ Tincturae iodi oij. 

Sig. : Apply as counter-irritant, and after pus is evacuated apply 

to the sac. — Bartholow. 

Use ether spray to produce local anaesthesia, for opening 
abscesses. 



40 A COMPENDIUM OF PRACTICAL MEDICINE. 

ACIDITY. 

Acidity is not a disease, but a symptom. As a symptom 
it has no special diagnostic value, for it is met with both in 
functional and in organic disease of the stomach. 

Excessive acidity occurs from various causes. The gastric 
juice may be secreted in large quantities, or it may contain an 
abnormal amount of acid. 

But excessive acidity is far more frequently due to the de- 
composition of food, and to a process of fermentation dependent 
rather upon scarcity than over -abundance of this juice. In this 
case it manifests itself only after meals. At the same time car- 
bonic acid gas may be generated, causing great distension and 
eructations, or belching, of sour liquid. 

Treatment. — Acids, given on an empty stomach, check the 
secretion of the acid gastric juice; given on a full stomach, they 
render its contents more acid; hence, if there is an excess of acid 
secreted by the stomach, they should be given before meals, in 
small doses and well diluted; while, if there is too little acid 
secreted, they may be given after meals, to supply the deficiency. 

PRESCRIPTIONS FOR ACIDITY. 

Jfc Acidi hydrochlorici diluti..... Sj. 

Sig. : Ten drops in water twenty minutes before meals. 

Jfc Tincturse nucis vomicae Sj . 

Sig. : Five drops in water fifteen minute before meals. — Ringer. 

Jfc Sodii bicaibonatis 3iij- 

In pulveres no xii. div. 
Sig. : A powder in a wineglassful of water after meals. 

— Alonzo Clark. 

{fc Sodii bicarbonatis 3j • 

Pulveris rhei Bss. 

Spiriti menthao piperita? 3ij- 

Aquas — q. s. — ad 5iv. — M. 

Sig. : A tablespoonful after meals. (For acidity, combined with 
constipation). — Bellevue Hospital. 



ACIDITY ACNE. 41 

jfc Pulveris ipecac gr. ss. 

Pulveris rhei gr. ij . 

Sodii bicarbonatis gr. xij . 

In pulveres no xii. dividenda. 
Sig. : One powder every four to six hours to an infant one year 
old. — J. Lewis Smith. 

Alkalies after meals are only palliative. 

jfc Glycerini Siv. 

Acidi tannici oij . — M. 

Sig. : A teaspoonful before, with, or after meals. — Bartholow. 

ACNE. 

Acne, called also Acne Vulgaris, or Varus, is an inflam- 
mation of the sebaceous follicles and glands, the result of 
accumulation and retention in them of sebaceous matter. If the 
sebaceous matter be retained without inflammation, the surface 
becomes studded with black specks, and the affection is known 
under the name of comedones, or black-heads. But, sooner or 
later, the sebum plugs give rise to irritation, act as thorns in the 
flesh, and excite inflammation and suppuration in the surround- 
ing tissues, and the patient is said to have acne. 

Acne is likely to occur in those whose skins are sensitive, or 
whose general health is disordered. It is a frequent affection 
and is resented by the upper classes of society on account of its 
disfigurement. It is rarely met with before puberty — usually be- 
gins between the ages of 15 and 25. Some thought that there 
was a connection between acne and the organs of generation, as 
a marriage would sometimes moderate its violence, and Eigler 
very rarely saw acne in eunuchs; but Hebra said, "I cannot 
agree with Plenck's dictum, ' Matrimonium varos curat, 1 but 
would rather say, 'Tempus varos curat.' " 

Symptoms. — Acne affects most frequently the face, neck, 
shoulders, back and chest. The starting points of the eruption 
is the accumulation of hardened plugs of sebum in the sebaceous 
follicles (comedones) which are black upon the surface, owing 
to admixture with particles of dust. Sometimes a small nodule 
surrounds each follicle, and we have acne punctata; sometimes 
the nodule becomes pustular, and we have acne pustulosa; some- 



42 A COMPENDIUM OF PEACTICAL MEDICINE. 

times there is a decided induration, or tubercle, acne indurata. 
In severe cases some of the sebaceous glands are apt to be the 
seat of distinct abscesses. If these inflammatory centres are 
allowed to run their course unchecked, they leave cicatrices 
which resemble the pits of small- pox, and as the eruption tends 
to occur in successive crops, in time the disfigurement may be 
considerable, hence the disease, though trivial, should be treated. 
A burning heat is occasionally complained of, and itching is 
common. 

Diagnosis. — Tar acne may be mistaken for acne, but the 
history of the patient having been exposed to the influence of 
tarry preparations, or their external use, would make the diag- 
nosis. In tar acne there is a black speck in the center of each 
nodule, as in acne. The eruptions which frequently occur in 
those who are taking the bromides or iodides sometimes resemble 
that of acne, but in them there is a history of the taking of one 
of these drugs, and there is an absence of black specks in the 
centre of the nodules. Syphilitic eruptions may sometimes be 
mistaken for acne; but in the former the eruption commences 
after the poison enters the system, usually affects all parts, is 
more or less coppery in chronic stage, is often in circles or seg- 
ments of circles, ulceration is common, itching absent always 
in early syphilis, eruption easily removed by anti-syphitic treat- 
ment; in the latter, the eruption commences between puberty 
and 25, is limited to face, chest and back, is bright red, is never 
in circles or segments of circles, no tendency to ulceration, itch- 
ing often present, eruption hard to remove by any kind of treat- 
ment. 

Treatments — Is both constitutional and local. If the patient 
is strumous, phosphorous and cod -liver oil in full doses should 
be given. If the eruption appears in an aggravated form, arsenic 
should be given. If suppuration is a prominent feature, the 
sulphide of calcium may be tried. 

The local treatment is the most important: 1. Press out 
the sebum plugs (comedones). 2. Bathe the affected parts every 
night and morning, with water as hot as can be borne, for ten 
minutes, and afterwards apply friction with rough towel. 3. 



ACNE. 43 

Acne indurata has been cured by applications of galvanism, both 
local and central. 

PRESCRIPTIONS FOR ACNE. 

|£ Syrupi hypophos comp Sviij. 

Sig. : A teaspoonful after each meal. (Acne indurata). 

— Bartholow. 

Jfc Liquor potassii arsenitis 5 vj . 

Sig. : Three drops in water after each meal. 

jfc Liquor potassse 3j. 

Aquae Rosse Siv. — M. 

Sig.: Apply with a soft sponge twice daily. Use mutton suet 
to face afterwards. — Bartholow. 

Jfc Calcii sulphidi gr. xv. 

Sacchari lactis 5 iij • 

In chartulas no Lx. div — M. 

Sig.: Take one powder three times a day. — Anderson. 

Jfr Sulphuris iodidi 5ss. 

Adipis gj. — M. 

Sig.: Use freely over the eruption night and morning. (In acne 
indurate and rosacea.) — Ringer. 

jfc Sulphuris 5j . 

Glycerini (Price) 5j • 

Cold cream Sj. — M. 

Sig. : To be applied firmly every night short of causing pain or 
inflammation. — Anderson. 

Jfc Potassii sulphureti 

Zinci sulphatis aa 5j- 

Aqua? rosae oj- — M. 

Sig.: Apply to the face on muslin twice a day and wash the face 
with tar soap. — Anderson. 

jfc Lactis sulphuris 

Glycerini 

Spirits vini rectificati 

Potassii carbonatis 

Aetheris sulphurici aa 5ss. — M. 

Sig.: Apply to face at bed-time. — Teissl. 



44 A COMPENDIUM OF PRACTICAL MEDICINE 

J& Sulpburis precipitatas 3ij- 

Camphor.. gr. x. 

Gum mimosa gr. xx. 

Aquae calcis 

Aquas rosas aa S iij . — M. 

Sig. : Shake the bottle. Apply at bed-time and in the morning 
remove the sulphur without wetting the skin. — Kummerfeld. 

J& Hydrargyri chloridi corrosivi gr. xx. 

Glycerini Sss. 

Spiriti vini rectificati Svij. 

Spiriti rosmarini 3iv. — M. 

Sig.: Apply to face. — Bartholow. 

Jfc Hydrargyri iodidi viridis gr. x. 

Adipis Sj . — M. 

Sig. : Apply to face. — Bartholow. 

J$- Hydrargyri iodidi rubri gr. v. 

Adipis , ,Sj.— M. 

Sig.: Apply to face. — Bartholow. 

j& Glycerini Sj. 

Sig. : Half teaspoonful after meals. — Bartholow. 

{& Sulphuris. 5j • 

Glycerini Sj . 

Aquas rosas ,, Sviij. — M. 

Sig.: Apply to face night and morning. — Ringer. 

J& Hydrargyri perchloridi Sj. 

Aquas destillatas Siv. 

Ovorum xxiv albumen 

Succi citri Siij. 

Sacchari Sviij. — M. 

Sig. : Apply to the face. — Hebra. 

The above is a cosmetic lotion much used by the Orientals 
as a beautifier of the skin, and is often of use in acne. 

(i- Potassii acetatis 5iv. 

Tincturas nucis vomicas 5ij- 

Extracti rumicis fluidi, ad Siv. — M. 

Sig.: One teaspoonful, well diluted after meals. — Bulkley. 



ACNE ACNE ROSACEA. 45 

J& Potassii acetatis Sj. 

Acidi acetici 3ss. 

Spiriti setheris nitrosi Siss. 

Extracti taraxaci fiuidi Sij. — M. 

Sig. : A teaspoonful before meals in water. — Bulkley. 

Jfc Sulphuris prsecipitatae 3 v. 

Glycerini 3iss. 

Spiriti camphorse Sj- 

Aquse giv.— M. 

Sig. : Apply with a brush to the affected part before retiring 
at night. — Lailler. 

|fc Sulphuris praacipitatse 5j- 

Glycerinse 3j • 

Spiriti vini rectificati Sss. 

Aquas rosae ad Siv. — M. 

Ft. lotis. 

Sig.: To be painted on at night after steaming the face and 
washing it with sand soap. To be washed off in the morning 
with warm gruel, and the face powdered with the following : 

Jfc Zinci oleatis 

Pulveris talc aa Sj- — M. 

Sig.: To be dusted on every morning. — Jamieson. 

ACNE ROSACEA. 

Called also Rosacea, or Copper-nose, is a very common affec- 
tion, but not so common as ordinary acne. 

Causes. — Intemperance is the most frequent cause in males. 
Debility is the usual cause in females. Those whose faces are 
exposed to great cold or heat, as cab- drivers, bakers and cooks, 
are liable to have copper-nose. In males the disease usually ap- 
pears about middle -life; in females about puberty, or the meno- 
pause. 

Symptoms. — The eruption always makes its appearance upon 
the face, as the nose, chin, cheeks or brow. The symptoms may 
be divided into three stages or varieties. In the first, there is 
simply dilatation of the small vessels and capillaries, with new 
formation of vessels. In the second, redness of the surface 



46 A COMPENDIUM OF PRACTICAL MEDICINE. 

makes its appearance, which is at first congestive and transitory, 
but finally becomes permanent, and slight desquamation takes 
place. The skin has a dusky tint, esjjecially after meals and in 
cold weather. In the third variety, owing to cell infiltration and 
the new formation of connective tissue, hypertrophy of the 
tissues of the skin is apparent, and the skin has a thickened and 
coarse appearance. 

Hebra describes the brandy -face and the wine -face. The 
brandy-face is frequently confined to the nose, where it dilates 
the blood-vessels, and the skin between is healthy. The wine- 
face is of a dark red color, and the skin has a solid redness, and 
the whole face has a bloated appearance. 

Treatment. — Constitutional treatment is very important. In 
cases of debility, a generous diet, tonics, especially arsenic, are 
indicated. The local treatment is even more important. If the 
blood vessels are very much dilated, they should be slit open, or 
punctured at each end, and touched with caustic, or they may 
be obliterated by electrolysis. The finest cambric needle, at- 
tached to the negative pole of the galvanic battery, is inserted 
into the lumen of the vessel, or perpendicular to the vessel at 
several points if a long one, and six to ten cells turned on, until 
the proper electrolytic action is developed. 

PRESCRIPTIONS FOR COPPER=NOSE. 

Jfc Hy drargyri 5iv. 

Terebinth commun 3 ij • 

Cera? navse oiij. 

Empl. plumbi Siss. — M. 

Ft. unguent. (See Acne Vulgaris). 

ADDISON'S DISEASE. 

Addison's disease is an affection of the suprarenal capsules. 
It is sometimes called the bronzed skin disease. 

Symptoms. — Extreme languor, muscles flabby, the pulse 
feeble, indigestion, anorexia and nausea, sometimes vomiting 
after eating. The skin is pigmented, and presents the color of 
a mulatto. 



AFTER PAINS. 47 

Prognosis. — It is an incurable disease. Its duration varies 
from one to live years. 

Treatment. — Sirup of the iodide of iron, cod-liver oil, chlor- 
ide of calcium, quinia, and arsenic may be tried. Faradism and 
galvanism have been proposed by Dr. Rockwell. 

Addison's disease is thought to be tuberculosis of the supra- 
renal bodies. 

AFTER=PAINS. 

The contractions of the uterus in the first few days after 
the birth of the child are the causes of what are termed after- 
pains. They may last four days, and are more pronounced in 
multipara? than in primiparse. They are to be regarded as a 
normal and favorable event. Where the uterus has been over- 
distended, as in twin pregnancies and hydramnios, the after-pains 
are especially severe. Suckling the infant produces reflex con- 
tractions of a somewhat severe character. 



PRESCRIPTIONS FOR AFTER=PAINS. 

|{r Morphinse acetatis gr. i. 

Extracti digitalis fluid i XRj . 

Spiriti Mindereri 5j — M. 

Sig. : One dose. Repeat if necessary. 

J£ Extracti ergotse fluidi 5iij- 

Extracti digitalis fluidi ITCxxiv. 

Quininse Sulphatis gr. xxiv. — M. 

Sig.: Fifteen drops three times daily. (To aid the process of 
involution). The quinine may be given in capsules in gr. ii. doses, 
if preferred. —Sloan Maternity. 

Jfc Chloral Hydratis gr. xv. 

Sig.: One dose. May be repeated if necessary. 

jfc Camphorse gr. x. 

Morphinse gr. J. — M. 

Sig. : One dose. — Bartholow. 



48 A COMPENDIUM OF PRACTICAL MEDICINE. 

AGALACTIA. 

Agalactia is imperfect lactation. 

PRESCRIPTIONS FOR AGALACTIA. 

j& Extracti pilocarpi fluidi % ij . 

Sig. : A teaspoonful two or three times daily. — Bartholow. 

Jfc Decocti gossypii Oj. 

Sig.: A wineglassful every half hour. — Phillips. 

AGUE. ( See Intermittent Fever). 

AGUE=CAKE. 

Is an enlargement of the spleen from malaria. 

Treatment. — Besides quinine in ordinary doses, there is no 
remedy more efficacious than the ointment of the red iodide of 
mercury rubbed in daily over the splenic region in the sunshine, 
until soreness of the skin compels a suspension. — Bartholow. 

ALBUMINURIA. 

Is simply albumen in the urine. It is not a disease, but a 
symptom. The existence of albuminuria is not proof positive of 
kidney disease. Albumen may be found in the urine in the 
course of a great many diseases. It is frequently found in the 
urine of persons who are apparently in perfect health. As a 
rule, albumen found in the urine denotes some kidney change. 

PRESCRIPTIONS FOR ALBUMINURIA. 

JJr Sodii iodidi gr. xv. 

Sodii phosphatis 3ss. 

Sodii chloridi Siij- 

Aquae — q. s. — add ft. sol — M. 

Sig. : To be taken in the course of the twenty-four hours. 

— Semmola. 



ALBINISM. 49 

Jfc Olei erigerontis 3ss. 

Sig. : Five drops on a lump of sugar every three or four hours. 
(In the chronic forms). — Bartholow. 

jfc Auri et sodii chloridi gr. iij. 

Hydrargyri chloridi corrosivi gr. v. 

Extracti gentianse q.s. — M. 

Ft. massa et in pil. no. lx. div. 

Sig.: One pill morning and evening. — Bartholow. 

Jfc Acidi gallici o i-ij . 

Acidi sulphurici diluti 5ss. 

Tincturse lupuli 5j . 

Infusi lupuli — add Syj. — M. 

Sig.: A tablespoonful thrice a day. (If urine is smoky). 

— Aitken. 
Jfc Misturse ferri et ammonii acetatis.Syj. 
(U. S. P.) 
Sig.: Two teaspoonfuls, well diluted, thrice daily. — Basham. 

jfc Ferri sulphatis gr. xv. 

Magnesii sulphatis Sij. 

Potassii bicarbonatis 5iij- 

Infusi buchu Sviij. — M. 

Sig. : A tablespoonful once or twice a day in a tumblerful 01 
water. (When constipation exists). — Fothergill. 

The skim -milk treatment of albuminuria is a success. 

— Donkin. 

The butter-milk cure may be substituted for the milk-cure 
in cases of stomach disease and in albuminuria. — Bartholow. 

ALBINISM. 

Is defective pigmentation in the skin, hair and eyes. The 
pigment of the skin is in the mucous layer of the epidermis. In 
this condition there is congenital absence of the coloring matter, 
and the skin is milky white, the hair white, long, fine, and silky, 
and the iris is rose colored, the pupil being red. 

There is usually intolerance of light and the Albino walks 
with the head downwards. 

This deformity is met with in all races, but it occurs most 
among the negroes of the South. 

It demands no treatment. 



50 A COMPENDIUM OF PRACTICAL MEDICINE. 

ALCOHOLISM. 

Is the physical and mental changes induced by alcohol. It 
may be acute or chronic. 

Mania a potu is acute alcholic delirium. 

Delirium tremens is a delirium with trembling occurring in 
the course of chronic alcoholism. 

Symptoms. — The symptoms are familiar to all. In the 
chronic form the appetite declines, the stomach becomes intoler- 
ant of food, and vomiting occurs. The old alcoholic suffers in 
the early morning before the morning dram. He strains and 
retches, and after great anguish, brings up only some glairy 
mucus and a little greenish matter. His memory grows weaker, 
his moral sense is blunted, he becomes morose and irritable, has 
headache, ringing in the ears, attacks of dizziness or vertigo, his 
vision grows dull, numbness, tingling, trembling, and paresis of 
muscles occur. He also becomes wakeful and nervous. Liver 
and kidney trouble supervene with ascites and puffiness of face. 

Treatment. — Withdraw the stimulant, be careful with his 
diet, give tonics such as quinine, tincture of nux vomica, etc. 

PRESCRIPTIONS FOR ALCOHOLISM. 

Jfcr Potasii bromidi 3j. 

Sig. : One dose. Repeat every four to six hours if necessary. 
(For the horrors.) — Bartholow. 

Jfc Tincturse gentianae comp 

Tincturse calumbse comp — aa Sij- 

Tincturse nucis vomicae Siss. — M. 

Sig. : A dessertspoonful before each meal. — Loomis. 

jfc Strychnise sulphatis gr. j. 

Aqua font ...Sj.— M. 

Sig.: Five minims increased cautiously to twenty minims 
hypodermically twice daily. (In both acute and chronic forms.) 

— Dobronravoff. 

(Jr Sol. nitro-glycerine (1 per cent)..3ij- 
Sig. : One drop every two hours. (In acute form, with cerebral 
anaemia and intense depression.) — Van Goidtsnoven. 



ALCOHOLISM ALOPECIA. 51 

jfc Spiriti ammonii aromatici oij. 

Tincturse camphorse 5iss. 

Tincturse hyoscy ami 3iiss. 

Spiriti lavandulse comp. q. s. addSij. — M. 
Sig. : A teaspoonful every hour until relieved. Then give 

ffr Pulveris capsici gr. ij. 

Quininse sulphatis gr. iij. — M. 

Ft. pulv. no. i. 

Sig. : To be taken before each meal for several days. — Aitken. 

Jfc Extracti lupulinae fluidi 

Tincturse capsici — aa Sj ■ — M. 

Sig.: One or two teaspoonfuls as necessary. (Best substitute 
for alcoholic stimulants.) — Bartholow. 

jfc Liquoris potassii arsenitis.. Sss. — M. 

Sig.: A half drop every half hour, for six or eight doses. 
(Vomiting of alcoholics.) — A. A. Smith. 

Jfc Sodii bromidi ,5ss. 

Chloral hydratis Siiss. 

Syrupi aurantii cort Sss. 

Aquas, ad giv. — M. 

Sig.: A tablespoonful at night. Repeat if necessary. (For 
sleeplessness.) — Aitken. 

Give opium and chloral very cautiously to old alcoholics. 
For the "alcoholic paralysis," or partial paraplegia use fara- 
dism and galvanism. 

ALOPECIA. 

Is baldness or loss of hair or defective growth. It may be 
congenital or acquired. It is a common thing for children to be 
born with very little hair, but it soon begins to grow; in rare 
cases it never makes its appearance. 

Congenital alopecia has also been observed in the lower 
animals, especially in a race of horses found in Little Thibet, on 
whose hide not a trace of hair can be discovered; also in a race 
of African dogs and hogs. 

Treatment. — Is both constitutional and local. Cod- liver oil 
and tonics, especially nerve tonics, as strychnia, phosphorus, and 
above all arsenic are usually indicated. 

The local treatment resolves itself into the use of reme- 
dies to stimulate the hair follicles, 



52 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR ALOPECIA. 

9 Tinrturae canthardis Sss. 

Olei ricini Siv. — M. 

Sig. : Rub well into the roots of the hair night and morning. 

— Waring . 

j& Tincturae cantharidis 3iss. 

Tincturae capisici ITt.xx. 

Glycerinae Sss. 

Spirit! odoratae — add Syj. — M. 

Sig. : Apply to head two or three times daily. — Gross 

J& Hydrargyri perchloridi gr. xij. 

Glycerini 3 vj . 

Spiriti rectificati Siij. 

Aquas destillatae — add Syj. 

Olei rosae XTT.j. — M. 

Ft. lotio. Apply to scalp night and morning. — Anderson. 

jfc Liquoris carbonis detergentis Sj. 

Glycerini (Price) 3 v j • 

Aquae destillatae Siv. — M. 

Sig.: Sponge the scalp night and morning. — Anderson. 

J& Pulveris cantharidis 3j 

Glycerini (Price) 3j . 

Unguenti simplicis 3yj. — M. 

Sig. : Apply firmly to the scalp night and morning. 

— Anderson. 

|& Tincturae macis ...3iss. 

Olei olivae — add Sij. — M. 

Sig.: Apply two or three times daily to affected spots. 

— Hebra. 

Jfc Quininae sulphatis 3iss. 

Spiriti vini rectificati Siv. 

Tincturae capsici 

Tincturae cantharidis 

Spiriti ammonii aromatici — aa...Sss. 

Glycerini Siv. 

Aquae q. s. — add Oj. — M. 

Sig.: Apply locally. — Brinton. 

Alopecia depending on Syphilis, Eczema and Psoriasis may 
be cured by the proper treatment for those affections. 

Pilocarpus is the most efficient remedy for alopecia which 
we possess. — Bartholow, 



AMAUROSIS AMENORRHEA. 58 

{& Extracti pilocarpi fluidi 3j. 

Tincturse cantharidis Sss. 

Linimenti saponis Siiss. — M. 

Sig.: The scalp must be well rubbed with this lotion daily. 

— Bartholow. 

AMAUROSIS. (Functional.) 

Amaurosis is partial or complete blindness. Amblyopia is 
impairment of vision. Since the ophthalmoscope has come into 
use, making the interior of the globe as accessible to our sight 
as the exterior, these terms have fallen into comparative disuse, 
and are used to designate conditions whose pathology is not 
known (functional). 

Causes. — 1. Traumatic. 2. By lightning. 3. Hemorrhage. 
4. Toxic, such as lead, osmic acid, silver and mercury, quinine, 
and salicylic acid. Alcohol and tobacco, which excite a peculiar 
partial neuritis, may cause amaurosis or amblyopia. 5. Uremic. 
6. Diabetic. 7. Hysterical. 8. Migraine. 9. Reflex. 

Treatment, — Depends on the cause. For toxic causes, suita- 
ble antidotes and abstinence suggest themselves. Galvanization 
and faradization may be tried. Amaurosis of a functional kind, 
from lead, tobacco and alcohol, may be cured by strychnine. 

PRESCRIPTIONS FOR AMAUROSIS. 

{fc Strychnise sulphatis ,...gr. j: 

Alcoholis 5j. 

Aquse destillatae — ad Siv. — M. 

Sig.: A teaspoonful thrice daily before meals. — Nagel. 

According to Coursserant, there is no remedy comparable 
to pilocarpine in the amblyopia of alcoholism and of tobacco 
abuse. Dose, gr. xVgr. ss. 

AMENORRHEA. 

Is abnormal suppression or absence of the menses. Primary 
amenorrhea, called also emansio mensium, is where menstrua- 
tion has never occurred. Secondary or accidental amenorrhcea 
has been called suppressio mensium. 

Causes. — Amenorrhea is, more frequently than to any other 
cause, due to anaemia of the ovaries, consecutive to chlorosis or 



54 A COMPENDIUM OF PRACTICAL MEDICINE. 

general anaemia, and dysinenorrhcea may depend, in one of its 
forms, at least, upon the same condition of the blood. — Bartholow. 

When the menses are absent at puberty it may be due to 
atresia of the uterus, vagina or vulva, or to bad hygienic sur- 
roundings, or to overwork at school. After the menses have 
become established, they may cease entirely from impoverish- 
ment of the blood, from debility resulting from a chronic disease 
or following an acute illness. 

Anaemia, chlorosis, Bright's disease, diabetes, cancerous and 
malarial cachexia, and pulmonary tuberculosis are all potent in 
producing amenorrhoea. 

Menstruation may be suppressed from some sudden emotion, 
anxiety, and from taking cold. 

Symptoms. — Abscence of the monthly flow is of course the 
chief sign. There may be headache, fever, pain in the chest and 
pelvis, acne, eczema, herpes, and urticaria. 

Science has on record some curious examples what may be 
called substituted secretions. 

Jones reports the case of a young woman in whom menstru- 
ation was checked apparently from sudden chilling, who then 
suffered from amenorrhoea, and for five years had, instead of the 
menstrual flow, an abundant flow of milk from the breasts which 
lasted for thirty- six hours. Periodical diarrhoea for three days, 
or leucorrhoea may replace the normal flow (Pozzi). 

Haemoptysis (spitting blood), haematemesis (vomiting blood), 
epistaxis (nose bleed), and rectal hemorrhages may replace the 
normal flow, and this is known as vicarious or ectopic menstru- 
ation. 

Treatment. — Depends on the cause. Where atresia exists, 
an operation is necessary. If the amenorrhoea be due to bad 
hygiene, or over- study, or poor health, correct these conditions. 
Pozzi says that it is a mistake to suppose that amenorrhoea calls 
for special medication supposed to have an elective action upon 
the uterine mucous membrane. Iron and aloes, and saline 
purgatives may be given in certain cases. Permanganate of po- 
tassium is said to be almost a specific. Apiol is sometimes of 
service. Mustard foot baths and mustard plasters to the thighs 
and hypogastrium, and the hot sitz-bath are important aids. 



AMENORRHEA. 55 

Tonics and good food must be given. Electricity (faradic) 
with one pole upon the lumbar region and the other externally 
over the site of the uterus has given good results (Rockwell). 

During pregnancy and lactation menstruation ceases; it re- 
turns only when the excess of nutritive material is no longer 
required for these purposes. 

Menstruation may then be considered a safety valve; its 
absence indicates a lowering of nutrition when it is not the re- 
sult of pregnancy. 

PRESCRIPTIONS FOR AMENORRHEA. 

|i Tincturse aconiti radicis 3ss. 

Sig. : One drop every hour. (When checked by cold.) — Ringer. 

|fc Potassii perrnanganatis 5j 

Ft. in no. xxx pellets. 
Sig.: One three times daily after meals followed by a glass of 
water. (Begin one week before the expected period.) — Bartholow. 

{i Auri et sodii chloridi gr. iij 

Aquse o viij . — M. 

Sig.: A teaspoonful after meals. — Bartholow. 

Jfc Extracti hydropiperis fluidi Siv. 

Sig.: Thirty minims four times a day, for a week before the 
menses ought to appear, when due to functional inactivity or torpor 
of the uterine system. 

Bartholow can confirm the statement of Eberle, who reports 
that " with no other remedy or mode of treatment has he been 
so successful as with this," in amenorrhcea. 

J& Apiol (parsley-camphor) 5j. 

Sig.: Six drops morning and evening for five days before the 
expected menstrual period. (When torpor of the ovaries and uterus 
exist.) — Biddle. 

{& Terebinthina? alba? 

Pulveris aloes 

Fern sulphatis exsic — aa gr. xx. — M. 

Ft. massa et in pil. no. xx div. 

Sig.: One thrice daily. — Parviu. 



56 A COMPENDIUM OF PRACTICAL MEDICINE. 

Jfc Extracti aloes aq 3j. 

Ferri sulphatis exsic 3ij • 

Asafoetidae giv. — M. 

Ft. massa et in pil. no. 100 div. 

Sig. : One pill after each meal, gradually increased to three. 

— Goodell. 

Jfc Tincturse ferri chloridi 5iij. 

Tincturse cantharidis 5j • 

Tincturse guaiaci ammonii gigs. 

Tincturse aloes Sss. 

Syrupi — q. s., add Svj. — M. 

Sig.: A teaspoonful thrice daily. — Dewees. 

ANEMIA. 

Is a morbid condition from diminution of blood or its nutri- 
tive constituents. Anaemia may be only a symptom of some 
other disease. It may be acute or chronic. Acute anaemia is 
the result of sudden and excessive loss of blood, as from wounds 
of arteries, post partum haemorrhage, and fevers. Chronic anae- 
mia may result from many forms of chronic diseases, as Bright's 
disease, malignant growths, tuberculosis, etc. Anaemia may 
also be caused by defective assimilation, an insufficient supply of 
food, frequent repetition of the sexual orgasm, profuse menstrual 
flow, prolonged lactation, pregnancy, poison in the blood from 
lead, malaria, etc. 

Symptoms. — The patient is weak and pale. His lips and 
tongue have lost their red color. The eye is pearly. His pulse 
is feeble, but generally accelerated. The appetite is deficient or 
depraved. The bowels are apt to be costive. Exercise induces 
great fatigue, shortness of breath and palpitation (DaCosta). 
There is mental depression. The hands and feet are always 
cold. Anaemic females complain of a pain in the left side and a 
burning sensation on top of the head. Over the jugulars, 
particularly the right, there is heard a continuous venous hum 
(Loomis). 

Prognosis. — Depends upon the cause of the anaemia. It is 
usually favorable. 



ANEMIA. 57 

Treatment. — The causes of ansemia are to be ascertained, 
and, if possible, removed. Good food is the first requisite. The 
appetite and digestion should be promoted by quinia and other 
tonic remedies. Exercise in the open air, daily sponging of the 
body, and sea-bathing have a favorable influence. Iron is the one 
drug that best combats anaemia (Loomis). It should be given 
after meals. Arsenic is another remedy often of much efficacy 
in the treatment of anseinia (Flint). It should be given in 
small doses for a long time. Loomis says that alcohol is food to 
anaemic patients, and that Burgundy, Madeira, and rich wines 
are to be preferred; but malt liquors are often more beneficial. 
Cod-liver oil, and the syrup of the lacto-phosphate of lime are 
of great service. The physician should encourage the patient. 
Central galvanization, and general faradization are of use to 
stimulate the functions of organic life (Bartholow). 

PRESCRIPTIONS FOR ANEMIA. 

j& Quininse sulphatis gr. xx. 

Ferri sulphatis exsiccat gr. xl. 

Strychnia? sulphatis gr. ss. — M. 

Ft. massa et in pil no xx. div. 
Sig. : One pill thrice daily. — Bartholow. 

jfc Tincturse ferri chloridi 5iv. 

Acidi phosphorici diluti 3yj. 

Spiriti limonis 3ij- 

Syrupi — q. s. add Svj. — M. 

Sig.: A dessertspoonful in water after meals. — Goodell. 

Jfc Hydrargyri chloridi corrosivi gr. i-ij 

Liquoris arsenici chloridi 5j 

Tincturse ferri chloridi 5iv. 

Acidi hydrochlorici diluti oiv. 

Syrupi Siij. 

Aquae — add 3 vj . — M. 

Sig.: A dessertspoonful in a wineglassful of water after meals. 

—A. H. Smith. 

{& Ferri sulphatis exsiccat 

Potassii carbonatis aa 5j. 

Syrupi — q. s., ut. ft. massa — M. 

Ft. massa et in pil no. xxiv. div. 
Sig.: One pill after meals. — Bland. 



58 A COMPENDIUM OF PRACTICAL MEDICINE. 

R Liquoris potassii arsenitis 5ss. 

Tincturse gentianse composite Sivss. — M. 

Sig. : Half teaspoonful after each meal. (Small doses of iron 
may be given with the above). 

R Syrupi calcii lacto-phosphatis Si v. 

Liquoris potassii arsenitis 3j — M. 

Sig.: A teaspoonful three times daily. (In anaemia of lactation 
and of suppuration) . — Bartholow. 

ANEURISM. 

Is a tumor, or sac, containing blood which communicates 
with the interior of an artery. Its walls are formed of the coats 
of an artery. 

Causes. — The aorta is the favorite site of aneurisms, because 
it is subjected to great strain. Powerful, muscular effort, syph- 
ilis, chronic arteritis, are the chief causes. Degeneration of the 
vessel walls, overaction of the heart, as in hypertrophy, gout, 
rheumatism and alcohol may cause aneurism. Exciting causes 
are: external wounds, fractures and dislocations, and sprains. It 
occurs most frequently between 30 and 50. 

Symptoms. — The earliest symptom of thoracic aneurism is 
pain. This may be a fixed pain, almost constant, and felt in one 
spot under the sternum, lancinating and tensive in character, 
shooting up to the neck and shoulders, down the arm to the 
elbows; or it is felt in the back and shoots around the chest. At 
times the attacks of pain are most severe, and demand the 
use of active anodynes (Bartholow). If erosion of vertebrae, 
sternum, or ribs occurs, there is a peculiar, constant "boring" 
pain. Pressure of the aneurism on the recurrent laryngeal 
nerves causes dyspnoea and the voice becomes husky. Pressure 
on the pneumogastric may cause vomiting and pyrosis. Pressure 
on the pulmonary plexus gives rise to a harsh, metallic, "brassy" 
cough. Pressure on the cervical sympathetic causes contraction 
of the pupil on the affected side, and irritation causes dilation 
of the pupil (Loomis). Pressure on the external jugular causes 
the head and neck to become turgid on that side. Pressure on 
the trachea causes dyspnoea and a stridulous cough (with no 



ANEURISM. 59 

expectoration) like a nervous cough. Pressure on the thoracic 
duct will cause mal- assimilation, wasting and inanition. 

The symptoms of aneurisms in general are: 1. Expansile 
pulsation. 2. Pressure on the artery above destroys the pulsa- 
tion and diminishes the size of the aneurism. 3. Aneurismal 
bruit — a rasping sound, like sawing wood. 4. Pain, due to 
pressure on the sensory nerves. The following tumors may be 
mistaken for aneurisms: 1. Pulsating sarcoma and soft vascular 
carcinoma. 2. Abscess lying on an artery. 3. Enlarged glands 
lying on an artery. 

A clean hypodermic needle may be thrust into the sac or 
tumor to make the diagnosis positive (Bartholow). 

Prognosis. — Unfavorable. 

Treatment. — Is both medical and surgical. Absolute rest 
is the first essential. The diet must be nutritive but unstimulat- 
ing. Iodide of potassium and ergot are the only drugs that have 
stood the test of time (Loomis). Morphine must be given for 
the 23ain. For cases amenable to surgical treatment, see works 
on surgery. 

PRESCRIPTIONS FOR ANEURISM. 

|fc Barii chloridi gr. xvij. 

Aquae Sj . — M. 

Sig. : Six drops in a tablespoonful of water three times daily 
after meals, for four or five months. — Flint. 

J& Potassii iodidi (grs. xv. — 5ss.) 

Three or four times a day. (This relieves pain and promotes 
coagulation of blood in the sac). — Bartholow. 

{& Antipyrin 5 iss. 

Syrupi tolutan oiss. 

Aquae — add 3 iij . — M. 

Sig.: A tablespoonful at intervals of one to four hours until 
relieved. (For cardiac pain). — See. 

I$* Potassii iodidi 5ss. 

Syrupi simplicis 5j . 

Aquae menthae piperitae — ad 5 iij- — M. 

Sig.: A teaspoonful three times daily, gradually increased to 
three teaspoonfuls, but diminished on any increase of pulse rate. 

— Balfour. 



60 A COMPENDIUM OF PRACTICAL MEDICINE. 

ANASARCA. 

Is not a disease but a symptom. It is a universal accu- 
mulation of serous fluid in the areolar tissue. (Edema is a 
localized collection of serum in the same tissue. These terms, 
therefore, differ in nothing but extent. (For treatment of these 
conditions see dropsy.) 

ANGINA PECTORIS. 

Is a neurosis of the heart characterized by pain, usually in- 
tense, burning, tearing or lancinating in character, in the pre- 
cordial region, radiating into the back, left shoulder and down 
the left arm, and accompanied by a feeling of constriction of the 
chest, and a strong sense of impending death. It is frequently 
associated with organic disease of the heart (Bartholow and 
Loomis). 

Treatment. — The affection is paroxysmal. There is a sud- 
den indescribable anguish, or "heart-pang" with a sense of 
suffocation, pale face, cold sweat, arterial tension high, action of 
heart disturbed. The paroxysms may last a few seconds only, 
or for hours, or even days (Bartholow and Loomis). 

Prognosis. — Unf ayorable. 

Treatment. — All causes of disturbance of the heart action, 
as tobacco -smoking, alcohol, over-ingestion of food, and excite- 
ment must be removed. 

Five drops of nitrite of amyl should be inhaled from a 
handkerchief during the paroxysm. 

Morphine hypodermically for pain. 

Nitro- glycerine to prevent the attacks. Fowler's solution, 
cod -liver oil and the hypophosphites should be given. Electri- 
zation has been found useful (Bartholow, Loomis and Flint). 

PRESCRIPTIONS FOR ANGINA PECTORIS. 

Ify Liquoris potassii arsenitis Sj. 

Sig. : Ten drops three times a day after meals. (Given during 
the interval.) — Bartholow. 

Jfc Amyl nitritis oij- 

Sig. : Two to ten drops on handkerchief for inhalation. 

- Brunton. 



ANTHRAX. 61 

Jfc Sol. nitroglycerine (1 per cent.)- • Sss. 
Sig. : One-half to two drops internally. (When pallor of face 
exists.) — Pepper. 

{fc Antipyrin 5j. 

Syrupi tolutan oj . 

Aqua? — add gij. — M. 

Sig.: A tablespoonful at intervals of one to four hours until 
relieved. — See. 

ANTHRAX. 

Commonly known as Carbuncle is a circumscribed, 
indurated, inflammation of the skin and cellular tissues. It is 
larger than a boil, and forms on the back or neck, sometimes on 
the face and buttock. Carbuncle is a far more serious affection 
than a boil, and occurs generally in men over 45. The pain is 
severe, sometimes intense; of a heavy, aching, throbbing, sting- 
ing, burning character. The inflamed area shows no disposition 
to become accumulated like a boil, but maintains its flat and very 
hard character. Little ulcers form on the dusky red skin which 
give it a sieve-like appearance, so numerous are the openings, 
and from these a whitish discharge exudes. Carbuncle, attack- 
ing the upper lip, is found to be an extremely fatal form of the 
disease, and kills by the onset of pyaemia (Flint and Anderson). 

Causes. — Poisonous, or irritating materials introduced into 
the skin; prolonged exjjosure of the skin to a scorching heat: 
low state of the nervous system and of the general health, pre- 
disjiose to their occurrence (Flint and Anderson). 

Treatment. — Begin treatment with a calomel purge. Give 
tonics, such as quinine and iron in full doses. Morphine may 
be needed to quiet pain. Apply heat in the form of a poultice 
with acetate of lead and opium. Paint with tincture of iodine. 
Mr. O'Ferral recommends continued pressure by applying collo- 
dion to the inflamed skin. 

Some authorities advise incision. 



62 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR ANTHRAX. 

J& Tincturse ferri chloridi Sj. 

Potassii chloratis 5 }■ 

Glycerinse 5 j . 

Aquae — add 5 iv. — M 

Sig. : A teaspoonful in a wineglassful of water every two 
hours. — Ringer. 

Jfc Lini farinse 

Aquse bullientis aa. q. s. 

M. et Ft. cataplasma. 

Sig. : Apply as hot as bearable and renew when necessary. 

— Rockwell. 

Faradization will hasten suppuration. 

ANESTHESIA. 

Is loss of sensation. It is of various degrees. It may be 
complete, or partial, or a mere benumbing, and may be located 
in any part of the body. It is a symptom of some organic or 
functional disease of the central or peripheral nervous system. 
Large doses of Indian hemp, of lead, or of arsenic may cause 
anaesthesia. We see it in hysteria, syphilis and rheumatism, and 
as a result of pressure on nerve trunks, and of disturbances of 
the circulation and abnormal conditions of the blood. In the 
parts affected with anaesthesia the nutrition is less active, and 
there is a feeling of numbness and the temperature lowered 
(Loomis). 

Treatment. — A good nutritious diet and tonics. For the 
curable cases of cutaneous anaesthesia, faradization is a specific, 
if any remedy can be said to be a specific for anything (Rock- 
well). Bartholow recommends strychnine. 

ANCHYLOSIS. 

Is a bony or fibrous union of the joint ends of bones, caus- 
ing immobility of the joint. Anchylosis is not a disease of itself, 
but may be the result of any disease or injury which interferes 
with the normal functions and motions of a joint. Anchylosis 
may take place even in a perfectly healthy joint by long- con- 



ANCHYLOSIS APHTHAE. 63 

tinned rest. It may be the most favorable termination that can 
occnr in many diseases and accidents of the joints. 

If anchylosis is the best result that can be obtained, then the 
surgeon should see that the elbow is anchylosed at a right angle, 
as the limb will be more useful, and the knee with the limb 
perfectly straight (Sayre and Bryant). 

Treatment. — If the anchylosis be fibrous, we resort to 
forcible movement to break up the adhesions. If it be bony, we 
divide the bone, or cut out a wedge-shaped portion. It may be 
necessary to divide the tendons before applying force. After 
breaking up the adhesions in the fibrous variety, passive motion 
may be resorted to. There is no treatment for bony anchylosis 
if the limb is already in the best position (Bryant). 

APHTHA. 

Are small white mucous ulcers of the mouth, especially of 
infants. Aphthous, follicular and croupous stomatitis are other 
names for this affection. The "aphthae," or white ulcers, are 
found on the internal surface of the lips, cheeks, tongue, gums, 
etc. The smallest of these patches are not larger than a pin's 
head. 

Causes. — Indigestion, diarrhoea, unripe fruit, candy and bad 
hygienic surroundings. 

Symptoms. — The constitutional symptoms are slight. The 
ulcers are painful; the child is fretful; the saliva is increased. 

Treatment. — Correct any intestinal disturbance that may 
exist with small doses of rhubarb and magnesia. Wash the 
mouth with a weak solution of glycerine and borax, or chlorate 
of potash. If the ulcers are slow to heal, touch them lightly 
with nitrate of silver. Bathe the feet in warm water. 

PRESCRIPTIONS FOR APHTHAE. 

jfc Bismuthi subnitratis Sj- 

Sig. : Apply dry to the ulcer. — Bartholow. 

Jfc Potassii iodidi gr. iv. 

Aquas 5J • — M. 

Sig.: Apply locally. — Bartholow. 



64 A COMPENDIUM OF PEACTICAL MEDICINE. 

J& Mel. boracis 5j. — M. 

Sig.: Apply to patches with a brush. — Ringer. 

(& Potassi chloratis gr. x. 

Aquae Sj — M. 

Sig.: Apply locally several times daily. — Brunton. 

J& Sodii salicylatis oiss. 

Aquae destillatae Sj- — M. 

Sig.: Apply five or six times daily. — Hirtz. 

APHASIA. 

Is inability to use spoken language or to give vocal utter- 
ance to ideas. Where the memory of words is lost, it is called 
amnesic aphasia. Where the power of expression is lost and 
the words remembered, it is called ataxic aphasia. Aphasia is 
really not a disease, but a symptom. 

Causes. — Aphasia is associated with a number of intra- 
cranial lesions; with occlusion either by thrombosis or embolism 
of the vessels; with cerebral hemorrhage; with encephalitis, 
abscess, meningitis, tumors; and it may be a merely mental and 
moral condition (Bartholow). 

Treatment. — The local disease on which the aphasia depends 
must be removed. If the aphasia persists after the local disease 
has been cured, much may be done by suitable training. 

APOPLEXY. 

Is sometimes used synonymously with cerebral hemorrhage, 
but incorrectly, since it is a symptom merely, and not a disease 
(Bartholow). DaCosta says that apoplexy is coma coming on 
rapidly, in consequence of the compression of the brain by ex- 
travasated blood, by the turgescence of the vessels, or by effusion 
of serum. 

Loom is limits the term cerebral apoplexy to non- traumatic 
hemorrhage into the cerebral substance or meninges. 

Causes. — Apoplexy is rare before 40 years of age. Miliary 
aneurism, periarteritis, fatty, atheromatous and fibroid degenera- 
tion of the walls of the vessels are causes of apoplexy, or cerebral 



APOPLEXY. 65 

hemorrhage. Other predisposing causes are: gout, rheumatism, 
syphilis, chronic Bright's, and chronic alcoholism. 

The exciting causes are: mental excitement, as in public 
speaking, sexual intercourse, straining at stool, and violent mus- 
cular exercises, and sudden stopping of bleeding piles (Flint 
and Loomis). 

Symptoms. — The seizure is generally sudden, and the coma 
quickly developed. The patient falls to the ground, bereft of 
all consciousness. In other instances, the apoplectic seizure is 
preceded by vertigo, dizziness, double vision, niuscse volitantes, 
flushing or pallor of the face, nausea, etc. During the coma the 
patient lies as if in a deep sleep, breathing laboriously and 
noisily, and each snoring inspiration is followed by a puffing 
sound. The pulse is slow, full, and at times irregular; the carotids 
throb violently. The pupils are immovable, and either con- 
tracted or dilated, and the eye is half open. In severe cases, the 
breathing becomes very irregular, of the Cheyne- Stokes variety. 

The coma may last from a few hours to two, three, or four 
days. Hemiplegia upon the side opposite to the hemorrhage is 
one of the most constant attendants of apoplexy, especially in 
the aged (Loomis). The eyes, and the head also, frequently 
deviate toward the side affected in the brain and from the 
side paralyzed; this movement constitutes a means of diag- 
nosis between cerebral hemorrhage and other causes of profound 
unconsciousness (Bartholow). 

Treatment. — The patient should be placed in a cool, airy 
apartment. Cold should be applied to the head, and heat to 
the feet. Attention must be directed to the bladder. An active 
cathartic should be given. If there are any paralyzed muscles, 
kneading, rubbing and electricity are the proper remedies. 

PRESCRIPTIONS FOR APOPLEXY. 

# Olei tiglii 5j. 

Sig. : Three or four drops may be given at once and repeated in 
three or four hours if free purgation be not produced. — Flint. 



66 A COMPENDIUM OF PRACTICAL MEDICINE. 

APPENDICITIS. 

Is an inflammation of the appendix vermiformis. 

Causes. — The usual causes are foreign bodies, such as in- 
spissated faeces, fruit seeds, worms, gall stones, catarrhal condi- 
tion and traumatism. It is most frequent in males from fifteen 
to thirty years of age. 

Symptoms. — At first there are slight localized pain and ten- 
derness in the right iliac region. Later on, there is pain in the 
groin, extending down the course of the anterior crural and 
through the hip. The slightest attempt at palpation gives the 
patient great dread. The thigh is flexed on the pelvis. 

The following symptoms are diagnostic of perforation or 
acute peritonitis: a sharp, sudden, intense pain in the iliac fossa 
which may extend to the navel, liver, or into the back, accom- 
panied by nausea, vomiting and chill. Temperature 101° to 102°. 

A circumscribed tumor is usually detected and sometimes 
fluctuation. 

Prognosis. — When perforation has occurred, unfavorable. 

Treatment. — Antiphlogistic measures locally, and opium in- 
ternally, but according to Loomis, it is best to make an explora- 
tory incision. 

ASCITES. 

Is a local dropsy — an accumulation of serum in the perito- 
neal cavity. The amount of fluid present in ascites may vary 
from a few ounces to five gallons (Loomis). It is usually of a 
light straw color. Ascites is a symptom, or an effect of disease, 
not strictly a disease in itself. 

Causes. — Ascites may be the result of disease of the perito- 
neum, or of obstruction in the main trunk of the portal vein, or 
in the branches of the vessel within the liver. Cirrhosis, throm- 
bosis, syphilitic hepatitis, abscess, cancer, and other tumors of 
the liver may cause ascites. Diseases of the heart or lungs may 
induce ascites in connection with general dropsy. Blight's dis- 
ease is a cause of hydremic dropsy. 

Symptoms. — The first is gradual enlargement of the abdo- 
men. There is no pain, tenderness, or any local subjective 



ASCITES ASTHMA. 67 

symptoms. The appetite is usually impaired. There is a feel- 
ing of fullness. There is dyspnoea. The umbilicus is bulged 
out. Flatulence and diarrhoea are frequently present. The 
superficial veins on the abdomen or chest are enlarged and tor- 
tuous. The shape of the abdomen changes with a change of the 
position of the patient. Fluctuation is present. On percussion, 
there will be flatness below the level of the fluid. Ascites may 
be mistaken for an ovarian cyst, a distended bladder, pregnancy, 
and hydatid cysts of the liver. 

Prognosis. — In most cases unfavorable. 

Treatment. — First, treat the cause if known. Try to remove 
the fluid by means of diuretics and hydragogue cathartics; but 
do not continue the treatment too long. The most efficient hy- 
dragogue is elaterium, and the potash salts, nitre, squills and 
juniper are the most efficient diuretics. As little fluid as possi- 
ble should be taken. Tapping is the surgical method of remov- 
ing the fluid. The puncture is made in the median line two or 
three inches below the umbilicus. Loomis is in favor of tapping 
before the fluid has caused pressure upon the viscera. The oper- 
ation of tapping involves little risk. Patients have tapped 
themselves. 

For the general health give quinine, iron and cod-liver oil. 

PRESCRIPTIONS FOR ASCITES. 

Jfc Elaterii gr. j. 

Ft. in no vi. pulveres. 

Sig. : One powder about 5 A. M. every other morning. 

—Salter. 

jfc Elaterii gr. ij . 

Ft. in no viii pulveres. 

Sig. : One powder at short intervals until abundant liquid evac- 
uations are produced. — Flint. 

jjr Pulveris jalapse compositi 3j. 

Ft. in no viii pulveres. 

Sig. : One powder in early morning. — liartholow. 

ASTHMA. 

Is a disease characterized by spasmodic difficulty of breath- 
ing, attended with wheezing and a sense of suffocation. It is a 
neuropathic affection, tonic spasms of the bronchial circular 



68 A COMPENDIUM OF PRACTICAL MEDICINE. 

muscular fibres being induced by a morbid excitation through 
the nervous system (Flint). 

Causes. — A peculiar susceptibility in some persons constitutes 
the predisposing cause. Heredity is traced in about forty per 
cent. The exciting causes are: irritating inhalations, such as 
ipecac powder, chemical vapors, smoke, dust, fog, emanations 
from new mown hay, stables, roses, sulphur matches, cats, horses, 
etc. (Loomis). Errors in diet, bronchial catarrh and feather 
beds are causes. 

Course. — The paroxysms last from two to six hours, but 
sometimes they persist for days (Bartholow). They take place, 
usually, during the sleeping hours. The patient is unable to lie 
down, but sits with the elbows on the knees near an open win- 
dow. A patient suffering from a severe paroxysm appears to be 
on the point of death. A frequent symptom is an itching sensa- 
tion under the chin. Speech is difficult. The patient may be 
cyanotic (Loomis). 

Prognosis. — Death rarely, if ever occurs from uncomplicated 
asthma. Asthmatics are long-lived. 

Treatment. — To relieve the paroxysm, no medication is so 
effective as the hypodermic injection of morphine (from A to 
\ gr). Chloral hydrate (gr. xx-xxx) is often equally effective 
(Bartholow). Nitrite of amyl by inhalation, three to five 
drops, sometimes affords relief. Inhalation of ether or chloro- 
form may be tried. Stramonium leaves may be smoked in a 
pipe. It often acts like a charm. 

PRESCRIPTIONS FOR ASTHMA. 

Jfc Potassii iodidi 3ss. 

Tincturse gentians comp Siij. — M. 

Sig. : One teaspoonful gradually increased to two teaspoonsful, 
three times daily for several months. — Alonzo Clark. 

Jfc Sodii iodidi gr. ij. 

Sodii bromidi gr. ij. 

Fluidi ext. euphorbia pil ZU iij. 

Glonoin gr. -fa. 

Tincturse lobeliae ZFL ij. 

(Hare's anti-asmatic tablet.) 

Sig. : One three times daily for sometime. 



ASTHMA ASTHENIA. 69 

$ Pyridin Sj. 

Sig. : Put on a hot plate in a small room, and send patient to 
inhale vapor several times. — German See. 

{& Tincturae sanguinarise 

Tincturae lobelias 

Ammonii iodidi — aa 3j • 

Syrupi to lutan 3 vj . — M . 

Sig.: A teaspoonful every two to four hours. (In humid 
asthma.) — Bartholow. 

J$r Ammonii bromidi 3iij. 

Ammonii chioridi 3 iss . 

Tincturae lobelias 3 iij . 

Spiritus aetheris compositi Bj« 

Syrupi acacias — ad d 5 iv. — M. 

Sig. : A dessertspoonful in water every hour or two during 
paroxysm. — Pepper. 

ASTHENIA. (Nervous). 

Literally signifies without strength. 

When the nervous system is without strength it is called 
nervous asthenia, or nervous debility, or nervous prostration or 
exhaustion, or simply neurasthenia. It is a morbid condition 
common in this country. 

Causes. — Sexual excesses, masturbation, excessive mental 
labor, late hours, long continued emotional disturbances of any 
kind, insomnia, improper food and the excessive use of tobacco 
or alcohol may excite it in persons of a neurotic temperament. 

Symptoms. — Physicians are often consulted by patients, who, 
although far from being well, have no well defined malady. 
They complain of languor, of being easily fatigued, and of 
aching of the limbs. They suffer constantly from dorsal and 
lumbar pains, and there seems to be no organ or part of the 
body free from some kind of disturbance. They imagine that 
they have some grave organic disease. There is a tendency to 
melancholia. There is anorexia, and the tongue is coated. 
Flatulence, dyspepsia, constipation, headache, palpitation of the 
heart, and tingling and creeping sensations are usually present. 
Chilly sensations alternate with flashes of heat. 

Prognosis. — Is always good. 



70 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — All causes producing neurasthenia should be 
removed. Rest, change of scene, nutritious diet, out door life 
and sound sleep tend to produce a cure. Faradism, galvanism, 
sea bathing and massage are of great value. Cod-liver oil, iron, 
strychnine, arsenic, phosphites and phosphates are useful. 

B Quinise sulphatis gr. xxx. 

Acidi sulphuriei diluti q. s. 

Aquse S ij. 

Tincturse ferri chloridi Bss. 

Spiritus chloroformi 3 vj . 

Glycerinse — add ........ Siv. — M. 

Sig. : ' A teaspoonful three times daily. — Loomis. 

APHONIA. (Nervous) 

Is loss of voice. When not dependent on either inflamma- 
tion or lesions within the larynx it is known as nervous aphonia. 

Causes. — Paralysis of the nerve of phonation (spinal acces- 
sory), and pressure on the recurrent laryngeal nerve by an 
aneurism, or other tumor will cause aphonia. 

Diagnosis. — In nervous aphonia the patient speaks in a pure, 
soft whisper, without effort. If the aphonia be due to laryngitis, 
the whisper is stridulous or husky and labored, and there is 
usually cough. 

Treatment. — Tonic remedies and invigorating hygienic 
measures are indicated. Moderate counter -irritation may be 
useful. The galvanic and faradic currents are used with much 
success. Sometimes a single application is followed by recovery 
of the voice (Flint). 

ASCARIS LUMBRICOIDES. 

Is the round worm found in the small intestine. It has a 
cylindrical form tapering toward both ends, like the common 
earth worm. The total number of eggs contained in a fully de- 
veloped female has been estimated at sixty millions. They hatch 
after being frozen or dried. The round worm occasionally enters 
the stomach and is vomited. Sometimes it ascends the oesoph- 
agus into the throat, and enters the larynx and causes death. 



ROUND WORMS. 71 

It has been found in the common bile-duct, gall -bladder, 
pancreatic- duct and vermiform appendix. These worms, when 
numerous, collect in balls, and are then difficult to expel, some- 
times causing obstruction. Length of worm, six to twelve 
inches. 

Causes. — The eggs are found in the drinking water, in fruits 
and vegetables which are eaten raw, and thus develop in the 
intestine. Filthy surroundings and uncleanliness favor their 
development. 

Symptoms. — The usual symptoms are colicky pains about the 
umbilicus, itching and picking at the nose, foul breath, bloody 
mucous diarrhoea, perverted appetite, restlessness, and disturbed 
sleep in which the child grinds its teeth, sometimes nausea and 
vomiting, tumid abdomen, whey-like urine, bluish color of 
eyelid, and there may be convulsions. But the only symptom 
which gives positive evidence of the existence of intestinal worms 
is their discovery in the stools or about the anus (Loomis). 

Treatment.— Santonine is the most effective remedy for round 
worms. Santonine affects the vision and makes all objects seem 
as if looked at through yellow- colored glasses (Bartholow). 
One -half grain for a child and three to six grains for an adult is 
a maximum dose (Loomis). The dose is given at night, fol- 
lowed by a laxative in the morning. 

PRESCRIPTIONS FOR ROUNDWORMS. 

ffc Olei chenopodii 3j. 

A cacise 5 ij • 

Syrupi simplicis Sj • 

Aquae cinnamomi 5 ij • — M. 

Sig. : Give a dessertspoonful three times a day for three days, 
and repeat after several days. — Smith. 

jfc Spiritus terebinthinse rec 3 ij- 

Olei limonis gtt. v. 

Mucil. gum acaciae 

Syrupi simplicis aa 5 yj. 

Aquae anisi 5 ii-iij . — M . 

Sig.: One teaspoonful every six hours. —Smith. 



72 A COMPENDIUM OF PEACTICAL MEDICINE. 

Jfc Extracti spigelise fluidi ^j 

Extracti sennse fluidi §ss. — M. 

Sig. : One teaspoonful to a child from three to five years. 

— J. Lewis Smith. 

ASPHYXIA. 

If the quantity of oxygen in the blood be greatly dimin- 
ished, there follows a group of symptoms to which the names 
suffocation, asphyxia and cyanosis are applied. 

Causes. — Obstruction or compression of the air passages, as 
in croup, pneumonia, phthisis, pneumo-thorax, asthma, oedema, 
etc.; also, obstruction to the circulation in the lungs, as from 
embolism of the pulmonary artery and in valvular lesions of the 
heart ; also irrespirable gases, etc. 

Symptoms. — Dyspnoea, convulsions, lowering of the tempera- 
ture, elevation of the blood pressure, at first slow pulse, then 
rapid, dilatation of the pupils, and dark blue color of the surface 
of the body. 

Treatment. — The treatment consists in removal of the cause, 
if possible, and in efforts to increase the quantity of oxygen in 
the blood. This increase is best affected by artificial respiration 
(Flint). 

ATHEROMA, OR CHRONIC ENDARTERITIS. 

Is an inflammation of the internal coat of the arteries with 
thickening in patches. Calcareous granules infiltrate the coat 
and render the artery friable. Atheroma is a common disease. 

Causes. — It is a disease of advanced life. It is predisposed 
to by gout, rheumatism, syphilis, Bright's disease, lead poisoning 
and especially by alcoholismus (Loomis). 

Symptoms. — Rigidity of the arteries, which are enlarged, 
lengthened and tortuous, is a prominent symptom. The pulse is 
feeble. The left ventricle is hypertrophied. The extremities 
are cold. The skin becomes dry. 

Prognosis. — It is a condition which cannot be cured (Loomis). 

Treatment. — Its treatment is altogether hygienic (Loomis). 
Bartholow gives arsenic when the eyes are puffy, breathing short, 
and ankles swollen. 



BACKACHE BALANITIS BALDNESS BED-SORES. 73 

BACKACHE. 

The backache so common in women and frequently due to 
anaemia of the cord, may be much relieved by a sponge dipped 
in hot water and passed over the spine. The hot douche to the 
spine is often more decidedly serviceable in these distressing 
cases (Bartholow). 

BALANITIS. 

Is an inflammation of the surface of the glans, penis and 
prepuce. 

Causes. — A long and tight prepuce is always a predisposing 
cause. The exciting causes are mechanical irritation or unclean - 
liness, or from prolonged contact with gonorrhoea^ leucorrhceal, 
menstrual, or other irritating fluids. 

Symptoms. — Kedness and swelling with ulceration and dis- 
charge, sometimes followed by phimosis, or paraphimosis. If 
gonorrhoea be the cause, it is called external gonorrhoea. 

Treatment. — Wash the parts with warm water, and dry them, 
and dust with calomel. If the ulcerations are deep, use iodo- 
form. A piece of lint or old linen is moistened in dilute lead 
water, or a gr. ij.-iv. solution of sulphate of zinc, and is laid 
around the glans, and the prepuce is pulled over it. This dress- 
ing should be repeated two to four times daily. If the prepuce 
cannot be retracted it may be washed out with a syringe. If the 
prepuce is much inflamed, rest, position, and evaporating lotions 
should be used. In cases of relapse circumcision affords a cure 

(Keyes). 

i 

BALDNESS. (See Alopecia.) 

BASEDOW'S DISEASE. (See Exophthalmic Goitre ) . 

BED=SORES. 

May be described as the death of a part from mechanical 
pressure. Bed-sores may arise in healthy subjects who are kept 
unmoved for ten to fourteen days. Dirt and moisture, under all 
circumstances, accelerate their appearance. 



74 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — " Prevention is better than cure." Since bed- 
sores are cansed by continued pressure, a change of the patient's 
position will relieve. The skin of the part pressed upon should 
be hardened by washing it twice a day with some camphor spirit 
and water, vinegar and water, or nitrous ether and water, in the 
proportion of one part to three. It is a useful practice to wash 
the parts threatened with bed-sores with whiskey or alcohol ; it 
hardens the cuticle, and prevents ulceration (Bartholow). Alum 
Sss., the whites of four eggs and tincture of camphor Sij., is 
an excellent application to bed-sores (Bartholow). 

Equal parts of tincture of catechu and liquor plumbi is a 
useful ajjplication to prevent bed-sores (Ringer). One of the 
best preventives of bed-sores is glycerine, or glycerine cream, 
rubbed over the part after washing it with tepid water (Ringer). 

The above applications are useless when the parts are about 
to slough. Water and air cushions should be employed to re- 
lieve the pressure. Dust iodoform over the sores. A linseed 
and bread poultice, with charcoal sprinkled upon the surface, is 
a good application (Bryant). 

BILIOUSNESS. 

Is a functional derangement of the liver. 

Causes. — It may be due to gastric and intestinal dyspepsia, 
to atony of the bowels, to malaria, to faulty diet, the food being 
too rich, to alcohol, to sedentary habits, and ill- ventilation, etc. 
(Loomis). 

Symptmos. — Anorexia, a bitter taste in the mouth, flatu- 
lency, acidity and pyrosis, a yellowish -coated tongue, yellow 
conjunctiva, muddy skin, nausea, constipation, headache, pain in 
the limbs, etc. 

Treatment. — The bowels should always be kept freely open. 
The alkalies are useful. The bromide of potassium, combined 
with ammonium chloride is highly useful. Mercury, in the 
form of blue pill, is very efficacious (Loomis). 



BILIOUSNESS BITES. 75 

PRESCRIPTIONS FOR BILIOUSNESS. 

Jfc Acidi nitromuriatici diluti 5j- 

Sig. : Ten or fifteen drops, well diluted, before meals. 

— Bartholow. 
{fc Ammonii chloridi gr. xxiij. 

Sig.: To be taken thrice daily in a glass of milk. — Murchison. 

jfc Sodii sulphatis 

Potassi et sodii tartratis aa...Sj- 

Infusi cascarillae ....Sviij. — M. 

Sig.: Two tablespoonfuls three times daily. — Fothergill. 

4 

|fc Aloni 

Extracti nucis vomicae aa gr. vj. 

Extracti belladonnas gr. iij. — M. 

Ft. massa et in pil. no. xxiv. div. 

Sig. : One or two pills at night, followed by a saline cathartic 
before breakfast. — Witherstine. 

BITES. 

The weaker solutions of ammonia are sometimes applied to 
the bites or stings of insects, as wasps, bees, spiders, etc., to 
neutralize the formic acid, the active principle of the poison 
(Ringer). Alcoholic stimulants are given to counteract the de- 
pressing effects of the bites of venomous snakes. The strong 
aqua ammoniae should be at once applied to the bite of venom- 
ous serpents, and of rabid animals (Bartholow). 

Potassium permanganate has been used with success as a 
remedy for the bites of venomous snakes and other animal pois- 
ons, applied locally and given internally (LaCerdo). 

PRESCRIPTIONS FOR BITES (SNAKE). 

Jfc Aquae ammoniae IHxxx. 

Aquae oiss. — M. 

Sig.: To be injected into the vein with hypodermic syringe. 

— Halford. 

J& Tincturae iodinii 5j- 

Sig.: Apply freely to the wound. — Weir Mitchell. 



76 A COMPENDIUM OF PEACTICAL MEDICINE. 

BLADDER DISEASES (See Cystitis). 
BLEPHARITIS 

Is an inn animation of the eyelid. There are various degrees 
and kinds of this affection. There may be a chronic hyperemia 
of the border, or some redness, with an accumulation of yellow- 
ish fatty material at the base of the lashes, or ulceration, minute 
abscesses, etc., and the hair follicles atrophy and the lashes fall 
out. This disease occurs most often in the young, with delicate 
skin and light hair, and in the strumous. It is sometimes a kind 
of eczema. In very many cases it is associated with some re- 
fractive or muscular error, and the proper glasses will correct it. 
The ailment is apt to be chronic (Noyes). 

Treatment. — Soothing lotions, warm water, or warm milk 
and water are useful; and at night a mixture of boracic acid 
powder and vaseline (gr. xxx to gj.) may be applied to lids. 
For the ulcerative forms, two grains of hydrarg. oxid. flavse to 
one drachm of vaseline, should be applied night and morning. 
If the patient is scrofulous, constitutional treatment must be in- 
stituted (Noyes). 

BLOODY FLUX. (See Dysentery). 
BOILS. (Called also Furuncle). 

A boil is a hard, bounded, deep-red, raised and very pain- 
ful swelling, situated in the subcutaneous tissue, occurring on all 
parts of the body, and usually terminating in suppuration. Boils, 
or furuncles, are met with in two forms, one as a subcutaneous 
affection, attended with little pain until the skin over it inflames 
and suppurates. It then appears as a conical-pointed swelling, 
with inflamed indurated areola; this causes severe distress, tension 
and throbbing, and is followed by relief when the "core" is 
discharged. 

The second form of boil begins as an inflamed follicle or 
pimple. It suppurates slowly. Such boils are usually multiple, 
and are often caused by the application of moist dressings or of 
some cadaveric irritant (Bryant). 



BOILS BLOOD POISONING BREATH. 77 

Causes. — No definite cause can be assigned in some cases. 
Boils occur in men and women who are in perfect health; but 
they are more common in debilitated jDersons, and in those who 
work in skin-yards, pathological rooms and dissecting rooms. 
They occur in the diabetic and cachectic subject, and are often 
the result of eating diseased meat (Bryant). 

Treatment. — Is both local and constitutional. The diet 
should be nutritious; fresh air, exercise, mild laxatives, warm 
baths, quinine, iron, arsenic and bitters are useful. The usual 
local treatment is a poultice to the part and free incision. For in- 
dolent boils, a drachm each of glycerine and extract of opium, 
and an ounce of resin cerate applied relieves the pain. Painting 
the boil with iodine is recommended. When the pain is great 
from tension, lancing relieves it. 

PRESCRIPTIONS FOR BOILS. 

Jfc Liquoris potassii arsenitis 5vj. 

Sig. : Three drops in water, three times daily after meals. 

{Jr Calcii sulphidi gr. ij. 

Sacchari lactis gr. xx. — M. 

Ft. in no. xx. pulveres. 

Sig. : One powder every hour or two. — Kinger. 

Faradization will hasten suppuration (Rockwell). 
BLOOD POISONING. (See Septicemia). 
BREATH (Foul). 

To correct fetor of the breath, the following formulae may 
be used: 

Jfc Calcis chloratse .., 5iij. 

Aquae destillatse Sij • 

Alcoholis S ij . 

Olei rosse gtt. iv. — M. 

Sig.: A teaspoonful to a tumblerful of water. — Bartholow. 

jjr Potassii permanganatis gr. viij. 

Aquae rosse 3 viij. — M. 

Sig.: Use as a mouth wash. This is an elegant toilet prepara- 
tion for destroying the odor of a foul breath, the smell of the axilla, 
and the fetor of the sweat of the feet. — Bartholow. 



78 A COMPENDIUM OF PKACTICAL MEDICINE. 

BREAST. (Inflammation of). 

The subcutaneous inflammation may be confined to the 
areola, and this -form generally terminates in suppuration. In 
other cases the inflammation may extend beyond the areola and 
give rise to localized abscesses. 

The treatment in both of these forms consists in the appli- 
cation of warm lead-lotions and in the early evacuation of the 
pus. To avoid cutting into the milk ducts the incision should 
radiate from the nipple (Lusk). Inflammation of the glandular 
structure of the breast develops usually in the first four weeks 
after confinement. The attack usually begins with a sharp chill, 
pain, high fever, and nodular enlargement of the breast. The 
mastitis that occurs three to four days after the birth of the 
child is, as a rule, insignificant, but the mastitis leading to 
abscess formation belongs to a later period, third or fourth week. 

Causes. — Are cold, blows, and "caking," but the lesions of 
the nipples are thought to be the main cause. 

Treatment. — Take the child from the breast, and in a very 
large number of cases the inflammation will disappear. For the 
pain, opium ; for the fever, a full dose of quinine should be 
administered. Give a saline cathartic. Belladonna in the form 
of an ointment may be applied to the breast, or lead- and- opium 
wash, or a large flax-seed poultice. As soon as there is evidence 
of pus, the abscess should be ojDened with antiseptic precautions 
(Lusk). 

BRONCHOCELE. (See Goitre). 

BUBONOCELE. (See Hernia). 

When the protrusion takes place above Poupart's ligament, 
through the internal ring, but does not traverse the inguinal 
canal sufficiently far to appear through the external ring, the 
hernia is called a bubonocele (Bryant). 

BORBORYGMUS. 

Is a rumbling noise of intestinal flatus, or wind, due to indi- 
gestion and decomposition of food. The noise can often be heard 
at a distance of ten feet or more when the person is walking. 



BORBORYGMUS BRONCHITIS. 79 

Treatment. — Give stomachic and intestinal tonics, snch as 
quinine in half grain doses three times daily, gentian, quassia, 
Colombo, and wild cherry. Liquids should be withheld and all 
articles difficult of digestion. 

BRONCHITIS. 

Is a catarrhal inflammation of the bronchial mucous mem- 
brane. 

Varieties. — 1. Acute bronchitis, of the large tubes. 2. Acute 
capillary bronchitis. 3. Chronic bronchitis. 

Morbid Anatomy. — There is first hyperemia or congestion of 
the mucous membrane, which becomes swollen and soft. Then 
follows the products of inflammation, such as mucus, pus- 
corpuscles, and serum mixed with desquamated epithelial cells. 
Generally the tubes on both sides are equally affected, and thus 
bronchitis exemplifies the law of parallelism, and is called a 
bilateral disease. In this respect it differs from pleurisy and 
pneumonia (Flint). 

Causes. — Exposure to cold damp Avinds, unsuitable clothing, 
depression of vitality, bad hygiene, and irritating gases are 
common causes. The predisposing causes are infancy and old 
age. 

Symptoms. — Its invasion is commonly marked by coryza, 
lachrymation, sore throat and slight hoarseness, with chilliness. 
The pulse is increased in frequency, and there is aching in the 
back and limbs. More or less pain and discomfort are felt be- 
hind the sternum. The cough is at first dry and hacking, but 
in a few days becomes loose, and is attended with a frothy muco- 
purulent expectoration. Acute bronchitis lasts from four or five 
days to two or three weeks. 

Differential Diagnosis. — Acute bronchitis may be confounded 
with pneumonia and pleurisy. The absence of lancinating pains 
in either side, the pain which is felt being substernal ; the pres- 
ence of more or less expectoration which is not rusty; the absence 
of accelerated breathing and dysphceia ; absence of the circum- 
scribed flush of the cheek; the pre-existence of coryza, arc usu- 



80 A COMPENDIUM OF PRACTICAL MEDICINE. 

ally sufficient to distinguish it from pneumonia and pleurisy. 
Besides bronchitis commences by chilliness persisting for several 
days — pneumonia by a distant and severe rigor. In bronchitis, 
the fever declines gradually, in pneumonia, there is a sudden 
defervescence. 

Treatment. — The combination of tartar emetic (gr. tV) and 
morphine (gr. T V) in some syrup of lactucarium, or in water, 
a mustard- plaster to the chest, and confinement to bed, will 
afford relief (Bartholow). In children, syrup of ipecac, syrup 
of tolu, and paregoric, usually suffice. If there is much fever 
and the pulse active, tincture of aconite root (gtt. j.) should be 
added (Bartholow). At the onset of the disease, it may be 
arrested by a Dover's powder (gr. x.) and warm bath at night, 
followed in the morning by a brisk saline purge ; or gr. xx. of 
quinine (Loomis). 

PRESCRIPTIONS FOR BRONCHITIS. 

jfc Tincturae sanguinariae 3j. 

Tincturae lobelia? 3] . 

Vini ipecac 3ij . 

Syrupi tolutan gss. — M. 

Sig. : A teaspoonful every three hours. ■ — Bartholow. 

Jfc Ammonii carbonatis gr. xL, 

Spiriti chloroformi §ss. 

Infusi senegae ^viij. — M. 

Sig.: Two tablespoonfuls every four or six hours. — Fothergill. 

Jfc Acidi hydrocyanici diluti HI xvi. 

Syrupi pruni Virginianae 

Aquae camphorae aa §j • — M. 

Sig. : A teaspoonful every two or three hours. — Hartshorne. 

Jfc Vini ipecac 3J . 

Tincturae scillae 31J. 

Syrupi tolutan £iv. 

Aquae %\ — M. 

Sig.: A teaspoonful every three or four hours. — Delafield. 

# Terpine hydrate 5ss. 

Sig. : Two to four drops on sugar every four hours according to 
child's age. — Cammann. 



BRONCHITIS. 81 

J& Vini ipecac 3ij. 

Liquor potassii citratis 5iv. 

Tincturae opii camphoratse 

Syrupi acacise aa 3j. — M 

Sig. : A tablespoonful three times daily. — DaCosta. 

|& Vini ipecac 5ij. 

Vini antimonialis ^j . 

Vini xerici 5iij- — M. 

Sig.: Three drops every hour to a child six months old. 

— Dessau. 

BRONCHITIS. (Acute Capillary). 

Acute bronchitis, by an extension of the inflammation to the 
finest tubes, becomes capillary bronchitis. Capillary bronchitis 
is more frequent in infancy and old age than at other periods 
of life (Bartholow). 

Symptoms. — So difficult is the breathing that the patient is 
unable to lie down, he sits inclined forward, and the respirations 
are shallow, reaching in the adult to forty, in infants to eighty 
per minute. The difficulty of breathing is incessant. The in- 
ferior part of the chest and the epigastrium are drawn in with 
each inspiration instead of being elevated, while the upper por- 
tion of the chest remains immovable (Bartholow). The speech 
is short and jerky; the alse nasi dilate, the face is congested and 
swollen, has a livid aspect, the lips become blue, and there is 
blueness of the finger ends, with fullness of the jugular veins 
(Loomis). Cough is more or less prominent. The expectoration 
is, at first, thick, viscid and tough, and when some is put in 
water the froth floats and is connected by filaments with the 
heavier masses underneath the surface. There is great restless- 
ness and anxiety. As death approaches, the pulse becomes small 
and thready, muttering delirium conies on, or the patient lies in 
a state of partial coma (Loomis). 

Physical Signs. — The presence of muco- purulent liquid in 
the small tubes gives rise to fine bubbling (subcrepitant) rales. 
As the affection is bilateral, the rales are heard on both sides. 

Differential Diagnosis. — Capillary bronchitis may be con- 
founded with pneumonia, asthma, pulmonary oedema, phthisis 



82 A COMPENDIUM OF PRACTICAL MEDICINE. 

and ordinary bronchitis; Lobar pneumonia is to be excluded 
by the absence of the symptoms and signs of that disease, such 
as dullness on percussion, the crepitant rale, pain in the side, the 
rusty colored sputum, etc. Asthma is not accompanied by 
pyrexia. In asthma the respirations are not rapid but labored. 

Prognosis — Unfavorable. 

Treatment. — Breathing warm vapor is highly useful, and 
the air of the room should be charged with steam during the 
-course of the disease. The temperature of the room should be 
kept at a high point, 85° to 90°. The iodide of potassium should 
be given freely (Flint). Muriate of ammonia, or chlorate of 
-potash in five or ten grain doses every two hours to an adult is 
useful (Loomis). Laxatives are useful and revulsive applica- 
tions to the chest. Emetics are sometimes indicated to promote 
the expectoration. In the advanced stage, quinine and stimu- 
lants must be given. 

PRESCRIPTIONS FOR CAPILLARY BRONCHITIS. 

Jfc Liquoris ammonii acetatis Sss. 

Syrupi ipecac 5j . 

Liquoris morphinse sulphatis ZHxL. 

Syrupi acacise Sj. 

Aquae Siss. — M. 

Sig. i A teaspoonful every two hours for a child two years old. 

— Meigs and Pepper. 

Jfc Tincturse aconiti radicis Sss. 

Sig.: One or two drops every hour. — Dessau. 

BRONCHITIS. (Chronic). 

Is a chronic inflammation of the mucous membranes of the 
bronchial tubes. When the secretion is retained and undergoes 
decomposition, as is apt to be the case when the tubes are di- 
lated, it is known as fetid bronchitis. 

The diagnosis is easily made. 

Treatment. — Iron, quinine, arsenic, lacto- phosphate of lime, 
hypophosphites, cod-liver oil, whiskey and strychnine, and a 
generous diet are indicated. 

For fetid bronchitis, the spray of a solution of carbolic acid 
is good. 



bright's disease. 83 

BRIGHT'S DISEASE. 

Acute Bright's disease, or acute diffuse nephritis, is a dis- 
ease of the kidneys characterized by albuminuria and general 
dropsy. It is an inflammation of the kidneys. Anasarca and 
serous accumulations in the plural, pericardial and peritoneal 
cavities are usually met with in the bodies of those dead of acute 
Bright's disease (Flint). 

Causation. — Acute Bright's disease may occur at any period 
of life. In the majority of cases it is a sequel of scarlatina. It 
may follow diphtheria and epidemic cholera. It may occur in the 
course of pulmonary tuberculosis, rheumatism, syphilis, typhoid 
and typhus fever, yellow fever, erysipelas, acute lobar pneu- 
monia, pyaemia, septicaemia, endocarditis, dysentery, carbuncles, 
small-pox and measles. As a primary affection it occurs 
especially in persons addicted to intemperance. It may be 
caused by exposure to cold, and by extensive burns. Other 
causes are, cantharides, turpentine, phosphorus, carbolic acid, 
iodoform, the mineral acids, arsenic, lead and mercury taken in- 
ternally (Bartholow, Flint, and Loomis). 

Symptoms. — Dropsy is an early symptom in the great major- 
ity of cases, but it is sometimes wanting. The oedema is gener- 
ally first observed on the face, particularly on the eyelids and 
around the eyes. There may be fever, thirst, anorexia, pain and 
tenderness in the loins. Pain over the kidneys may be wanting. 
The quantity of urine is usually diminished, and it may be very 
scanty. The urine contains albumen frequently in great abund- 
ance. In some cases the urine has a reddish-brown, smoky ap- 
pearance from the presence of blood. Blood casts, epithelial 
casts, and hyaline casts are usually present in the urine. Urea 
may collect in the blood and cause uraemia. Impaired vision 
and amaurosis are among the effects of uraemia. Blindness in 
acute albuminuria is generally sudden; but is often temporary. 
The ophthalmoscope shows no morbid appearances within the 
eye. The morbid condition is central. The average duration of 
the disease is about four weeks (Flint). 

Prognosis. — Exclusive of uraemia and serious complications 
the prognosis is favorable (Flint). 



84 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — Trie patient should be kept warm in bed. The 
diet should be unstiniulating. Dry cupping over the loins, saline 
laxatives, and fomentations over the region of the kidneys are 
useful. For the dropsy elaterium is the most prompt and relia- 
ble hydragogue. The diuretics to be used are bitartrate of 
potassa, the infusion of digitalis, and the decoction of broom. 

Of all diuretics, water is the best. 

Good sudorific remedies are pilocarpine and the liquor am- 
monise acetatis (Flint). 

PRESCRIPTIONS FOR BRIGHT'S DISEASE. 

jfc Acidi gallici 3i-ij 

Acidi sulphurici dil £ss. 

Tincturse lupuli 3j 

Infusi lupuli ad 5 vi. — M. 

Sig. : A tablespoonful thrice daily. (If urine is smoky). 

— Aitken.. 

jfc Ferri sulphatis gr. xv. 

Magnesii sulphatis 5 ij . 

Potassii bicarbonatis 3iij • 

Infusi buchu 3 viij. — M. 

Sig. : A tablespoonful once or twice a day in a tumblerful of 
water. — Fothergill. 

fy Infusi digitalis Sviij. 

Sig. : A tablespoonful morning and evening. 

(For the dropsy of Bright's Disease. — Bartholow. 

Albuminuria, dropsy, and uraemia are common to both acute 
and chronic Bright's Disease (Flint). 

BUBO. 

Is a circumscribed swelling and inflammation of the groin,, 
or of a lymphatic gland, syphilitic or otherwise. 

Varieties. — 1. Simple inflammatory bubo. 2. Virulent bubo.. 
3. Syphilitic bubo. 

Causes. — Simple inflammatory bubo is very common with 
chancroid, and may occur with any inflammatory lesion, as gonor- 
rhoea, syphilitic chancre, herpes, and balanitis. This form is 
also known as sympathetic bubo. It is the same inflammatory 



BUBO. 85 

glandular swelling as occurs after vaccination, or from an in- 
flamed corn. Any inflammatory lesion of the penis may be ac- 
companied by a simple bubo, (single or double) in the groin. 
Chancroid is the most common exciting cause (Keyes). 

Virulent bubo, the pus of which is auto-inoculable, can be 
found in connection with no other conceivable lesion than chan- 
croid. It is usually single, in one gland, on one side. It sup- 
purates necessarily. Simple bubo usually does, but may not 
suppurate. Pure syphilitic bubo does not suppurate. 

Bubo is more common in the male than in the female. 
Sometimes in double bubo, simple bubo will exist on one side 
and virulent on the other (Keyes). 

Diagnosis. — Syphilitic Bubo: 1. Nature: It is a specific 
affection. 2. Its frequency: It is a constant symptom attending 
syphilitic chancre. 3. Number of glands involved: Usually 
more than one. 4. Date of appearance: It develops during the 
first or second week of syphilitic chancre. 5. Size: The glands 
are usually only slightly enlarged. 6. Induration: The glands 
are specifically indurated, feeling like cartilage, oi wood. 7. 
Evidence of inflammation: None; the glands are freely movable 
among the tissues. The skin is neither adherent nor red, nor is 
there any pain. 8. Termination always in resolution. 9. Auto- 
inoculability: In cases of suppuration the pus is not auto-inoc- 
ulable. 10. Natural duration is a few weeks or months. 11. 
Prognosis is good as far as local results are concerned, but the 
patient invariably has syphilis. 12. Local treatment is inef- 
fective (Keyes). 

Bubo of Chancroid: 1. Nature: It may be simple or viru- 
lent. 2. Its frequency: It is a complication, occurring about 
once in three cases. 3. Number of glands involved: Usually 
consists of a single gland in any part of the body. 4. Date of 
appearance: There is no fixed date. 5. Size: The gland is 
greatly enlarged. 6. Induration: No hardness except inflamma- 
tory. 7. Evidence of inflammation: There is every appearance 
of inflammation. The gland becomes fixed, the skin adherent, 
the part feels hot, there is pain, the skin reddens. 8. Termina- 
tion: Occasionally by resolution, usually by suppuration. Viru- 
lent bubo invariably suppurates and becomes an open chancroid 



86 A COMPENDIUM OF PRACTICAL MEDICINE. 

ulcer. 9. Auto-inoculability: When the bubo is inflammatory 
the pus is not auto-inoculable; where it is virulent the pus is 
invariably auto-inoculable. 10. Natural duration is a few weeks 
or many months as a chancroid. 11. Prognosis is good for sim- 
ple, less so for virulent, and, in neither case, does syphilis follow. 
12. Local treatment useful and necessary (Keyes). 

Treatment. — The preventive treatment of simple bubo is 
rest, and absolute destruction of the chancroid with caustics. 
Tincture of aconite and belladonna, combined in equal parts, are 
of some use locally, especially if combined wuth rest. Tincture 
of iodine is useless, if not harmful, in acute advancing bubo. 
The above treatment, combined with a light poultice, will often 
avert impending bubo (simple). Blisteis may avert suppuration. 
Pressure is sometimes effective, if ajoplied early. If the tendency 
to suppuration advances, very slowly, the bubo is certainly 
simple; if rapidly, virulent. When opened spontaneously or by 
art, the outlet does not enlarge in simple bubo; in virulent bubo 
it does. If suppuration can be arrested in an inflamed gland, it 
must have been simple bubo, (unless syphilitic); virulent bubo 
must necessarily suppurate. It is a good rule to open the bubo 
early in any case, if pus be present. . The treatment of syphilitic 
bubo is that of early syphilis (Keyes). 

PRESCRIPTIONS FOR BUBO. 

jfc Cerati resinse comp 5j. 

Olei Olivse oi-ij. — M. 

Sig. : Spread on lint and apply. (To hasten suppuration and 
granulation). — Witherstine. 

Jfc Sol. hydrogen peroxidi...lO vol...Sviij. 
Sig.: Apply after suppuration has begun. — Ringer. 

(fc Tincturse iodi Sj 

Sig. : Apply with brush every other day, till skin becomes tender. 

— Van Buren. 

BUNION. 

Is an enlargement and inflammation of the bursa situated 
upon the side of the great toe at the metatarso- phalangeal junc- 
tion. Inflammation of this bursa is frequently so severe that 



BUNIONS BURNS AND SCALDS. 87 

the reflex contractions which follow produce a sub -luxation at 
this joint. The bursa may suppurate. The pain is sometimes 
intense and torturing (Sayre). 

Causes. — Ill-fitting boots and shoes, and weight from over- 
standing. 

Treatment. — Under all circumstances, the pressure must be 
removed. A wide and easy boot should be worn. To the in- 
flamed bunion water dressing is the best application. By means 
of Sayre's apparatus keep the great toe in a straight line with 
the foot. 

PRESCRIPTIONS FOR BUNIONS. 

Jfc Acidi tannici , 

Cosmolini aa 5 ij ■ — M. 

Sig. : Apply to joint after skin has been removed by blister. 

— Gross. 

gr Tincturse iodi 

Tincturse belladonna aa 5ij- — M. 

Sig.: Apply twice daily with a brush. — A. U. Med. Sci. 

BURNS AND SCALDS. 

A burn is casued by the application . of concentrated dry 
heat to the body; a scald by the application of hot or boiling 
liquid. In a burn of the first degree, there is mere redness fol- 
lowed by desquamation. In the second degree, there is inflam- 
mation and a blister. In the third degree, the superficial layer 
of the true skin is destroyed, and when shed, the nerves are ex- 
posed and pain severe. In the fourth degree, the whole thick- 
ness of skin is destroyed, and when the dry eschar comes away, 
a tedious process of suppuration and granulation takes place. 
In the fifth degree, the skin with the deeper parts is a black 
mass. In the sixth degree, the whole thickness of the limb is 
carbonized (Bryant). 

Prognosis. — A superficial burn spread over a large 1 surface is 
more fatal than a deep burn on a small surface. When more 
than half of the body is injured by a burn or scald, a fatal result 
generally follows. In both old and young all burns of any 



88 A COMPENDIUM OF PRACTICAL MEDICINE. 

extent are serious. Burns of the chest, abdomen, head and face 
are followed by much more severe symptoms than more exten- 
sive burns of the extremities (Bryant). 

Symptoms. — The earliest symptoms are those of shock. The 
skin is cold, accompanied by shivering. The pulse is rapid and 
feeble. The pain is severe and of greater intensity in slight than 
in deep burns. In the worst cases, pain is nearly or quite absent. 
In children vomiting is an early symptom. The patient may 
lapse into a drowsy condition followed by coma and death. If 
life be prolonged, reaction sets in after twenty-four to forty- eight 
hours, and traumatic fever. In severe burns we may have ulcer- 
ation of the duodenum (Bryant). 

Casting Off of Sloughs. — The slough separates in about four- 
teen days, and then suppuration commences. In the suppuration 
stage, there is great danger of exhaustion, hectic or pyaemia. 
The granulating surface is a long time in healing, and is followed 
by contraction if the whole skin has been destroyed. 

Cause of Death. — When a person dies from a burn within 
forty- eight hours, it arises from shock, or collapse ; when he dies 
in the stage of reaction or of inflammation, it is from visceral 
complication ; and when during the third or suppurative stage, 
from exhaustion, visceral changes or pyaemia (Bryant). 

Treatment. — Is both constitutional and local. Prevent col- 
lapse by use of stimulants and external warmth ; allay pain by 
local treatment and morphine ; maintain the strength by such 
food as milk, beef-tea, eggs, etc. 

Local Treatment.— Blisters should be opened carefully. 
Exclude the air as much as possible. At Gruy's hospital the 
application of carron oil, consisting of equal parts of lime water 
and linseed oil, applied on lint, has long been the favorite 
remedy. At University College the burn is covered with wheat 
flour. Zinc ointment on lint is used at London Hospital. Dr. 
dross used white lead paint. Bryant uses vaseline and finely 
powdered boracic acid spread on lint. In small burns, two parts 
of collodion to one of castor oil is used, or one ounce of carbolic 
acid to a pint of olive oil, or an ointment of carbolic acid 5iv., 
lard 5iv., and castor oil 5j. Extension must be kept up to 
prevent contraction. Skin-grafting may be necessary. 



BURNS AND SCALDS CALCULI. 89 

PRESCRIPTIONS FOR BURNS AND SCALDS. 

jjr Acidi carbolici gr. viij. 

Vaseline ^ij . — M. 

Sig. : Spread on lint and apply where the skin is broken. 

— Bellevue Hospital. 

jfc Sodii bicarbonatis ^ij 

Aquse Oj. — M. 

Sig.: Apply freely on lint or soft cotton. 

Jfcr Oleilini 

Liquoris calcis aa ^iv. 

Acidi carbolici gtt. xxx — M. 

Sig.: Apply freely. — Charity Hospital. 

jfc Cocaini gr. x-xx. 

Boroglyceridi §ij. — M. 

Sig. : Apply locally on absorbent cotton. — Eller. 

ffcr Saloli 3sb. 

Liquoris calcis 

Olei olivge ...aa §..ij. — M. 

Sig. : Use locally. — Nicot. 

CALCULI. (Biliary, Renal, and Vesical.) 

When bile is retained in the gall-bladder for a long time it 
decomposes, and the cholate of soda and other bile salts, with 
cholesterine, globules of bile -resin and granules are precipitated, 
and combine to form concretions, which are called biliary cal- 
culi, or gall-stones. Catarrh of the gall-bladder always accom- 
panies this retention and decomposition of bile (Loomis). 

Number of GaII=Stones. — Varies. Single calculi are rare. 
Eight thousand were found in one case. Their usual number is 
about thirty. Their size varies from that of a pin's head to that 
of a goose egg. In shape they are originally spherical, ovoid, or 
pear-shaped, but when they lie in contact with one another they 
may have facets. 

Color. — They may be light brown, or greenish yellow, or 
white, green, blue, red or black. Gall-stones will not float in 
water. In most cases a fresh biliary calculus can be crushed 
between the fingers. A gall-stone may form in the smallest 



90 A COMPENDIUM OF PRACTICAL MEDICINE. 

radical of trie hepatic duct. Trie gall-bladder may be normal or 
enlarged, and is often adherent to adjacent organs. Ulceration 
of the walls may take place and form openings, called biliary 
fistula. When calculi are found in the smaller ducts, they may 
excite abscess of the liver. Gall-stones may cause intestinal 
obstruction (Loomis). 

Causes. — Gall-stones may be formed at any period of life, 
but are most frequent after thirty- five. They are more common 
in women than in men on account of their less active mode of 
life. Those who have to pass the greater part of their lives in 
bed, and prisoners, are especially liable to gall-stones. The 
predisposing causes are, a diet rich in fats, animal food, alcoholic 
beverages, cancer of the liver, catarrh of the gall-bladder, etc. 
(Loomis). 

Symptoms.-The severely painful sensation produced by the 
passage of a gall-stone is called biliary colic. Usually after a 
hearty meal, or after some jolting exercise, as horseback riding, 
the patient is suddenly seized with a severe pain in the epigas- 
trium, which is increased by change of position or pressure. 
Sometimes nausea precedes the colic. The pain is paroxysmal, 
situated over the gall-bladder, radiates backward and upward, 
and may extend over both hypochondriac regions. It is a boring, 
tearing, piercing, or lancinating pain. It is often so agonizing 
that patients will roll about the floor or bed. The face is pale 
and covered with cold sweat. The abdominal muscles are rigid 
and pressure greatly augments the pain. Fatal syncope has 
occurred during an attack of gall-stone colic. After a few hours, 
sometimes a day, of exhausting and intense pain, the patient 
experiences sudden relief, and the pain entirely disappears. 
Jaundice is often present, but not until the attack has continued 
for twenty-four hours. After the attack, gall-stones may be 
found in the faeces (Loomis). 

Differential Diagnosis.— Gall-stone colic may be mistaken 
for cardialgia, intestinal, and renal colic. In cardialgia, pain 
comes on immediately after eating; gall-stone colic has no neces- 
sary connection with taking food. In cardialgia, the symptoms 
are referred to the epigastrium alone, while in biliary colic, the 
pain shoots to the right shoulder and back. In cardialgia, the 



CALCULI. 91 

pain gradually diminishes; in biliary colic it suddenly ceases. 
In gall-stone colic, the presence of a gall-stone in the faeces is 
pathognomonic. In intestinal colic, the pain begins at the um- 
bilicus, and radiates over the abdomen. In gall-stone colic, the 
pain has its seat at the free border of the ribs, and shoots to the 
back and upward to the right shoulder. In intestinal colic, pres- 
sure relieves the pain; in gall-stone colic it aggravates it. In 
intestinal colic the pain is intermittent; in gall-stone colic it is 
constant, though paroxysmal. In intestinal colic, jaundice is 
never present, while it may exist in bilary colic. In renal colic, 
the pain shoots from the region of the affected kidney to the 
inner part of the thigh and end of the penis, and the testicles are 
retracted; in gall-stone colic the direction of the pain is upward 
and backward. In renal colic, there is a constant desire to mic- 
turate. There is no urinary disturbance in biliary colic 
(Loomis). 

Prognosis. — Oft repeated attacks of biliary colic are bad. 

Treatment. — Relieve the pain by morphine hypodermically, 
inhalations of chloroform or ether; two or three leeches over the 
gall-bladder is often followed by relief. Large draughts of warm 
water, containing bicarbonate of soda often relieves the pain. 
Wrap warm clothes around the abdomen. If there are signs of 
collapse, give stimulants (Loomis). A gall-stone patient must 
not have wine or fats. He must exercise in the open air. A 
prolonged course of alkaline mineral water has been found the 
best remedy against the formation of gall-stones. Ether, turpen- 
tine, chloroform and hydrate of chloral have been proposed as 
specifics, it being thought they have the power of dissolving the 
gall-stones. According to Bartholow, the most effective remedy 
for the removal of the conditions which lead to the formation of 
biliary calculi, or to bring about their solution, is sodium phos- 
phate. He prescribes this in drachm doses, three times daily, 
dissolved in sufficient hot water, and taken before meals. This 
remedy is continued for several weeks or months. Vichy water 
should be used. 



92 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR BILIARY CALCULI. 

jfc Sodii bicarbonatis £v. 

In chartas no. xx div. 
Sig. : One powder three times daily for several months (Prophy- 
lactic). — Alonzo Clark. 

Jfc Chloroformi giv. 

Sig.: To be inhaled, a small quantity at a time until paroxysm 
ceases. — Ringer. 

{£r Sodii phosphatis ^ss-iss. 

In chartas no. xx div. 

Sig. : A powder before each meal continued for months (Pro- 
phylactic). — Bartholow. 

jfc Olei olivse optim Oj. 

Sig. : To be taken in divided doses before breakfast. 

jfc Morphinse sulphatis gr. 1 -J . 

Atropine sulphatis gr. y-J^ 

Aquae q. s. — M. 

Sig.; To be injected hypodermically during the paroxysm, and 
repeat if necessary. — Bartholow. 

CALCULI. (Renal). 

Renal calcnli are concretions formed by precipitation of 
certain substances from the urine about some body or material 
acting as a nucleus (Bartholow). They may be deposited in the 
tubes of the pyramids, in the cortical substance, or in the pelvis 
of the kidney. By far the most frequent variety is uric acid. 
Oxalate of lime may form the starting point of uric acid de- 
posits. Phosphatic, next touric, are the most frequently encoun- 
tered calculi. Mixed calculi are common. They vary in number. 
A kidney may contain one or a large number of concretions. 
They vary in size from a pin's head to a hazel nut; the larger 
ones may fill the whole pelvis; the smallest constitute "kidney 
gravel." If the larger ones obstruct the ureters, they become 
the cause of pyelitis, pyonephrosis, hydronephrosis, or abscess 
(Loomis). 

Causes. — Renal calculi occur at all ages, and are very fre- 
quent in children before the fifth year, and from five to fifteen. 



CALCULI. 93 

Males are much, more liable to them thau females. A sedentary 
life favors their development. The nuclei of renal calculi may 
be pus, blood, epithelium, or grains of pigment. 

Symptoms. — Usually there is an aching pain in the lumbar 
region and loins, which frequently shoots into the testicles, or 
labia, and down the inner side of the thighs; an itching at the 
end of the penis, and a frequent desire to urinate. The urine 
often contains pus, blood and tailed epithelium. The passage of 
a calculus along the ureter into the bladder is marked by sudden 
and intense pain in the region of the affected kidney, and is 
called renal colic. The urine is scanty or suppressed, and what 
is passed is of a smoky, high color, often bloody, and is dis- 
charged in drops, with a painful, burning sensation. The testi- 
cle of the affected side is retracted. When the calculus is washed 
into the ureter, an atrocious pain suddenly seizes the j)atient, 
who cries out, rolls from side to side, or rushes up and down the 
room. The face is pale and torn with agony, and the body is 
covered with a cold sweat. There may be nausea or vomiting, 
syncope or convulsions. The thigh of the affected side is be- 
numbed (Bartholow). The paroxysm, after some minutes or 
hours, usually terminates suddenly by the escape of the stone 
into the bladder. If the calculus become impacted in the ureter 
it will ulcerate through and give rise to a fatal peritonitis. 
Gravel may occasion no distress at all, or at most some little 
burning at micturition. After the passage of a calculus into 
the bladder, it will soon be found in the urine voided, or remain- 
ing in the bladder, it increases in size, and forms a vesical calculus. 

Diagnosis. — By remembering the diagnostic points the diag- 
nosis is easy. 

Prognosis. — Usually good. 

Treatment. — To relieve renal colic, give morphine hypo- 
dermically, warm baths and hot poultices to the loins and abdo- 
men. Inhalation of ether or chloroform will give relief. If 
gravel or sand of uric acid is present, probably the best prepara- 
tion is the officinal liquor potassii citratis, of which a table- 
spoonful may be taken every three hours (Bartholow). The 
faithful use of alkaline water not only delays, but often arrests 
the formation of renal calculi (Loomis). The Lithia, Carlsbad, 



94 A COMPENDIUM OF PRACTICAL MEDICINE. 

Vichy or Ems waters are efficacious. In five -sixths of the cases 
the urinary concretions consist of uric acid, and this forms the 
red sand which quickly collects around the sides and bottom of 
the vessel containing the urine. The urine in these cases is 
always acid. In cases of uric acid gravel, the urine is too con- 
centrated. The alkaline remedies above are indicated, with a 
large amount of water. The concretions may consist of the 
earthy salts, namely, the phosphate of ammonia and magnesia, 
and the phosphate and carbonate of lime. Ammonio-magnesian 
calculi are liable to form in cases of cystitis. These concretions 
are generally not renal but vesical. The urine in these cases is 
usually alkaline, and the mineral acids are indicated, either the 
sulphuric or hydrochloric. The nitro-hydrochloric acid is espec- 
ially indicated in cases of oxalate of lime gravel. The ingestion 
of large quantities of water form a highly important part of the 
treatment in all cases of gravel. 

PRESCRIPTIONS FOR RENAL AND VESICAL CALCULI. 

5 Liquoris potassae 3ij. 

Infusi buchu 5 viij . — M. 

Sig. : Three tablespoonsful an hour after meals. (When urine 



acid.) 

R Lithii citratis... 5ss. 

Syrupi aurantii cort 5j. 

Aquae ad ...giij. — M. 

Sig. : A tablespoonful in a wineglass of water three times daily. 

-Guy. 

Tfr Magnesii carbonatis 3j. 

Sodii biboratis 

Acidi citrici aa 5ij • 

Aquae bullientis S viij . — M. 

Sig.: A tablespoonful three or four times daily. (When urine 
acid). — Bartholow. 

R Acidi nitrici diluti 

Acidi hydrochlorici diluti aa...3iij- 

Syrupi auranti cort 

Aquae aurantii flor aa 3j. 

Aquae destillatae Sxiiiss. — M. 

Sig.: A wineglassful three or four times daily. (When urine 
alkaline). — Druitt. 



CARCINOMA. 95 

R Acidi nitrici diluti 

Acidi hydrochlorici diluti aa IRxL 

Infusi serpentarise 5 viij . — M. 

Sig. : A half wineglassful three times daily. (When urine alka- 
line). — Bird. 

R Ammonii benzoatis ■ 5ii-iij. 

Syrupi Siss. 

Aquae ad gyj. — M. 

Sig. : A tablespoonful two or three times daily. (When urine 
alkaline). — Seymour. 

R Strychnia^.... gr. j. 

Acidi nitrici diluti 5j. 

Aquae Sxij . — M. 

Sig.: Two tablespoonsful three times daily. (When urine alka- 
line). — Bird. 

CARCINOMA, OR CANCER. 

Is a tumor with a specific arrangement of the cells in spaces 
called alveoli. 

Theory. — Conheim has advanced the theory of the embry- 
onic origin of tumors, the germs of the tumor, perhaps consist- 
ing of misplaced embryonic cells, are brought by the individual 
into the world. They may remain dormant for a variable length 
of time, and then under the influence of some exciting cause, 
possibly an injury, may begin to grow. 

Cause. — Nothing is definitely known as to the origin of 
cancer, in any situation, but there is one thing certain, it is a 
disease of advanced life, and is more apt to appear from forty to 
sixty than at any other period. 

CARCINOMA OF THE STOMACH. 

Of all the organs of the body, the stomach is most frequently 
the seat of cancer — more frequently than the uterus, which 
comes, strictly, next. As regards age, the majority of cases occur 
at fifty, but the disease may appear at any time from forty -five 
to sixty. It is very rare from thirty to forty (Bartholow). Ac- 
cording to Loomis, the stomach, next to the liver, is the most 



96 A COMPENDIUM OF PRACTICAL MEDICINE. 

frequent seat of internal cancer ; one -third of all the cases of 
primary cancer have their seat in the stomach. According to 
Welch, quoted by Flint, the stomach, next to the uterus, is the 
most frequent seat of primary carcinoma. 

Cause. — Hereditary predisposition is undoubtedly its most 
important etiological factor. Beyond this its etiology is obscure 
(Loomis). 

Symptoms. — Anorexia, nausea, vomiting, pyrosis, soreness 
over the stomach are the earliest symptoms. After a time the 
pain becomes lancinating, fixed and constant. There are three 
prominent causes of the vomiting : First, from obstruction. 
When the obstruction is at the cardiac orifice, vomiting occurs 
immediately after eating ; when at the pylorus, the food is re- 
tained for one or two hours. Second, from irritation. Third, 
from fermentation. The absence of hydrochloric acid from the 
gastric juice is held to be an infallible sign of cancer. When 
the cancer ulcerates, the most constant symptom is hemorrhage 
(" coffee -ground" vomit). The stools have a dark, tarry appear- 
ance. Emaciation, debility, haggard look, and yellow skin are 
often present. By palpation, a hard, irregular and nodulated 
tumor may be discovered. 

Differential Diagnosis. — Cancer of the stomach may be mis- 
taken for gastric ulcer, and abdominal aneurism. Ulcer of the 
stomach occurs most in young adults, especially females, while 
cancer is seldom met with in persons under forty. In cancer 
there is usually a history of hereditary cancer. The pain in 
cancer is continuous, and described as lancinating ; while in 
ulcer the pain is intermittent, greatly increased by taking food. 
Hgematemesis, in cancer, has a sooty or "coffee- ground" appear- 
ance, is small in amount, and appears late in the disease, while 
in ulcer it is bright red arterial blood, is profuse, and appears as 
an early symptom. Vomiting in cancer does not relieve the 
pain, and is not very severe ; but in ulcer it is severe, and relieves 
the pain. The presence of an epigastric tumor establishes the 
diagnosis of cancer. An aneurismal tumor is smooth and ovoid; 
a cancerous tumor is hard and irregular. In aneurism, there is 
an expansile pulsation, while in cancer this impulse is lifting in 
character (Loomis). 



CARCINOMA. 97 

Prognosis. — Is always unfavorable. Its shortest duration is 
seven weeks, and its longest three and one -half years, the aver- 
age being one year (Loomis). 

Treatment. — Is altogether palliative. As to diet, milk and 
beef juice are the best. The burning pain is much diminished 
by washing out the stomach once a day with the stomach pump. 
BartholoAv recommends equal parts of pure carbolic acid and 
tincture of iodine, of which one or two drops may be given in 
water three times daily. For the pain, give morphine hypoder- 
mically. Arsenic, in the form of Fowler's solution, one or two 
drops, three times a day, has power to allay pain and retard the 
growth. 

CARCINOMA OF THE INTESTINE. 

Cancer of the intestine is usually primary. The rectum is 
its most frequent seat, then the anus, the caecum, the sigmoid 
and the colon (Loomis). 

Cause. — The cause is obscure. It is a disease of advanced 
life (after forty). Males are affected three and a half times 
oftener than females. 

Symptoms. — There are pains in a fixed situation, a gradually 
developing cachexia, and the presence of a tumor. The pain at 
first is slight, then acute and sharp. The patient declines in 
strength and weight, has a feeling of fatigue, a fawn- color com- 
plexion, bluish- white lips, a skin dry, wrinkled and scurfy. In 
cancer of the stomach and intestines the patients usually suffer 
from a profuse salivary flow without apparent cause. Constipa- 
tion is the rule (Bartholow). In cancer of the rectum, hard 
nodular masses may be felt. 

Prognosis. — Is always unfavorable. A fatal termination 
will be reached in a year or two. 

Treatment. — The treatment is only palliative. The pain 
must be relieved by morphine, hypodermically. The diet should 
consist of milk, nutritive broths, eggs, etc. Arsenic may relieve 
the pain and retard the growth (Bartholow). The formation of 
an artificial anus is a surgical means of prolonging life. 



98 A COMPENDIUM OF PRACTICAL MEDICINE. 

CARCINOMA OF THE LIVER. 

Cancer of the liver may be either primary or secondary. It 
is secondary to cancer of the stomach in one-half of the cases. It 
has been estimated that one out of every one hundred persons 
has cancer of the liver (Loomis). 

Cause. — The cause is unknown. Hereditary predisposition 
exists in most cases. It occurs most often between the ages of 
40 and 65. Medullary cancer of the liver sometimes occurs in 
early life. 

Symptoms. — The patient gradually loses ilesh and strength, 
complains of a sense of weight and fullness in the region of the 
liver. The pain soon becomes lancinating, and is localized at 
some point over the liver, which is tender to pressure. There is 
loss of appetite, flatulence, nausea, vomiting. Jaundice is pres- 
ent in one-half of the cases. Ascites occurs more frequently than 
jaundice. (Edema of the feet comes on late. The temperature 
is normal or sub -normal. Palpation discloses an enlarged liver, 
tender to pressure, with hard, smooth nodules over its surface 
(Loomis). 

Prognosis. — Cancer of the liver is a fatal disease. The aver- 
age duration is about one year (Loomis). 

Treatment. — Is palliative. Regulate the diet. Relieve the 
pain by a hypodermic of inoiqjhine. There is no remedy for 
cancer in any situation. Ascites will require attention by tap- 
ping. 

CARCINOMA OF THE KIDNEY. 

Cancer of the kidney may be primary or secondary. 

Causes. — The cause is obscure. It occurs in early life, be- 
fore five, and in old age. 

Symptoms. —There is gradual emaciation, soreness in the 
lumbar region, and hgematuria. 

Prognosis. — The prognosis is always bad. The termination 
is invariably death. 

Treatment. — Is palliative. Relieve the pain and sustain the 
patient. 



CARCINOMA CARIES. 99 

CARCINOMA OF THE LUNG. 

Cancer of the lung is usually secondary, and very often suc- 
ceeds to cancer of the breast removed by amputation. It may be 
primary, but rarely so. It is a disease of advanced life and is 
extremely rare before forty (Bartholow). 

Cause. — The cause is obscure. Hereditary predisposition is 
a most influential factor. 

Symptoms. — There is usually pain in the chest and a cough 
accompanied by a muco -hemorrhagic expectoration resembling 
currant jelly (Loomis). There is dyspnoea, emaciation, fever r 
night- sweats, with failure of strength, and haemoptysis. 

Prognosis. — Is always unfavorable. 

Treatment. — Is altogether palliative, and is restricted to the 
relief of symptoms. 

CARCINOMA IN OTHER ORGANS. 

Cancer of the arteries, brain, gall-bladder, heart, tongue, 
larynx, oesophagus, mediastinum, pancreas, pericardium, plura, 
and spleen is met with. In some cases it* is primary, in others 
secondary. The cause is obscure. The prominent symptoms 
are pain, the cancerous cachexia, and a tumor. The prognosis is 
unfavorable, and the treatment is only palliative. 

CARIES. 

Is inflammation and ulceration of bone; while necrosis is 
its death en masse. Bones of spongy texture are more frequently 
attacked by caries than such as are compact. The bones of 
young persons are more often the seat of caries than those of old 
subjects. On examination, the bone is found to be soft and dark 
red; its cells are filled with a reddish, serous, glary fluid, or with 
soft granulations of feeble vitality. It is always vascular and 
readily bleeds on being touched. It is occasionally painful. 

Causes. — The predisposing cause is some constitutional dis- 
order, scrofula, or syphilis. The exciting cause may be a blow 
or injury. 



100 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — Correct the constitutional disorder and give 
tonics, fresh air and baths. The usual remedies employed in 
scrofula and syphilis are indicated. Locally, the best treatment. 
is to freely expose and remove the diseased portion of bone. 

PRESCRIPTIONS FOR CARIES. 

B Cupri sulphatis 

Zinci sulphatis aa partes xv. 

Liquoris plumbi subacetatis 

partes xxx. 

Aceti partes CC. — M. 

Sig. : To be injecd through the sinuses. — Villate.. 

B Syrupi calcis lactophosphatis ^viij. 

Sig.: A dessertspoonful to a tablespoonful three times daily. 

— Bartholow. 
Cod-liver oil should be given to promote constructive meta- 
morphosis (Bartholow). 

CARBUNCLE. (See Anthrax). 

CATARRH (Nasal, called, also, Coryza). 

Is a catarrhal inflammation of the nasal mucous membrane- 
It is commonly called "cold in the head." 

Causes. — Atmospherical causes are the most frequent and 
influential. The exposure of the neck to a current of cold air, 
of the feet L and ankles to cold and dampness, passing from a 
warm to a cold atmosphere, and from a cold to a warm atmos- 
phere suddenly, are among the most usual causes. Irritating 
gases and vapors or dust may cause coryza. Epidemic influence 
now and then prevails on an extensive scale (Bartholow). 

Symptoms. — Taking cold in the head is announced by chilli- 
ness, weariness, headache, and general muscular soreness. An 
intense hyperemia is the first change, with an arrest of secretion.. 
This is soon followed by swelling of the membrane, and the 
nose feels dry, stuffed and uncomfortable, and an inclination to 
sneeze is often felt. Presently the nose pours out an abundant 
watery and saline discharge. The discharge soon assumes a 
purulent character. The voice has a nasal tone. The acute 



]STASAL AND FAUCIAL CATARRH. 101 

form terminates in fourteen days. The chronic may last for 
years. The discharge of the chronic form consists of greenish, 
offensive pus, or scales. If the mucous membrane is destroyed 
~by ulcerations, and caries of the bone has occurred, the case is 
then called ozsena (Bartholow). 

Treatment. — Where there is a strumous diathesis cod-liver 
oil. the phosphates, iodide of iron, etc., should be employed. 
Try to abort an acute attack by the administration of a full dose 
of quinine (gr. xv.) and morphine (gr. ss.) for an adult. When 
established, the best remedy is Lugol's solution, liquor iodi com- 
positus, one drop every hour or two. If there is fever, one drop 
of tincture of aconite root every hour will prove efficient. If the 
secretion is watery and profuse, tincture of belladonna may be 
given with the aconite, two drops every two hours. In the local 
treatment of chronic catarrh, the post -nasal syringe and tepid 
water containing a little common salt are the best materials for 
cleansing the passage. The tincture of iodine and carbolic acid 
may be readily volatilized and inhaled from a small bottle. A 
cocaine tablet containing gr. i~i in the form of a flattened disc, 
introduced alongside the septum, one on each side, twice or three 
times daily, is more successful. Very dilute solutions of chlorate 
of potassa, chloride of ammonium, sulphates of zinc, cadmium 
and copper, and acetate of lead, may be tried (Bartholow). 

According to Bartholow, the most effective application is a 
powder composed of tannin and iodoform (5i.-gr. x.) applied 
by means of an insufflator. DobelFs is an efficacious cleansing 
solution in chronic nasal catarrh, hypertrophic nasal catarrh, 
atropic nasal catarrh, and fetid nasal catarrh (ozsena). 

PRESCRIPTIONS FOR NASAL AND FAUCIAL CATARRH, 

J& Cocaine muriate gr. vj 

Bismuthi subcarbonatis 5ss. 

Talc 5iss. — M. 

Sig. : Enough to cover a silver five cent piece, insufflated into 
each nostril every two hours. (For acute coryza). — Sajous. 

{fc Tincture aconiti radicis , .3J . 

Tincturse Belladonna3 gij . — M. 

Sig.: Three drops every hour. (Pharyngitis and acute ton- 

silitis). — Ringer. 



102 A COMPENDIUM OF PRACTICAL MEDICINE. 

j& Chloroformi 3ij. 

Glycerinse 

Spiritus vini galici aa Sj. — M. 

Sig. : One teaspoonful in water every three hours. (For acute 
coryza). — Sajous. 

{& Acidi carbolici liq IUxxx. 

Sodii biboratis 

Sodii bicarbonatis aa 3j • 

Glycerinae oiiiss. 

Aquae q. s., ad., ft Siv. — M. 

Sig.: To be used with atomizer. (Simple chronic rhinitis). 

— Dobell. 

Jfcr Sodii bicarbonatis Sj. 

Sig.: Insufflate or apply with the finger to the inflamed tonsil. 
(Tonsilitis.) — Gine. 

Jfc Resorcin gr. v.-x. 

Aquas destillatse Sij . — M. 

Sig. : Used with atomizer twice daily, four minutes each time. 

— Masini and Maseei. 

CATARRH. ( Chronic Gastric.) 

Causes. — In many persons there is an hereditary tendency 
after middle life, to chronic gastric catarrh. The principal gen- 
eral cause of this affection is angemia. The most common local 
cause is the daily use of alcoholic stimulants. Diseases of the 
liver, heart and lungs which offer an obstacle to the venous 
return, will induce chronic gastric catarrh. Highly- seasoned 
foods, condiments, sauces, hasty and insufficient mastication, the 
frequent use of ices, and overfeeding are the principal causes. 
The prolonged use of arsenic, mercury, cubebs and purgatives 
often causes it. Finally, scrofula, syphilis and gout predispose 
to it (Bartholow and Loomis). 

Symptoms. — After taking food, the patient has a feeling of 
weight, or fullness, sometimes of pain. Sometimes when the 
stomach is empty, sometimes when it is full, the pain is greater. 
The symptoms of indigestion are usually present. There may be 
loss of appetite, nausea, vomiting of acid mucous in the morning 
or after meals. It is this acid material belched up into the 
oesophagus that causes "heart-burn." There is gaseous disten- 



CATARRH. 103 

tioii of the stomach. Palpitation, headache, and vertigo may be 
present. 

Treatment. — Begulation of the diet is the most important in 
all stomach diseases. When the starches, sugars and fats reach 
the stomach, fermentation begins. To exclude these articles, 
then, is the first step toward a cure. A curative measure of the 
highest importance is the " skim-milk cure," which consists in 
the exclusive use of milk, about four ounces every three hours, 
for some time. The stomach pump is very effective for cleansing 
the stomach in these cases. One or two drops of Fowler's solu- 
tion, three times daily before meals, continued for a month or 
more, is a remedy of the highest importance. When there is 
much acidity it may be checked by muriatic acid given before 
meals. Carbolic acid alone or with bismuth relieves the fermen- 
tation and gaseous eructations (Bartholow). 

PRESCRIPTIONS FOR CHRONIC GASTRIC CATARRH, 

{fc Liquoris potassii arsenitis 5ss. 

Sig. : One or two drops before meals. (Vomiting of drunkards.) 

— Bartholow. 

J& Extracti hyclrastis fluidi Sss. 

Sig. : Five to fifteen drops before meals in water, to be continued 
some time. — Bartholow. 

{& Tinctura:- cinchonse comp ,..5iv. 

Tincturae capsici 5ss. 

Tincturae mucis vomicae 5ij- — M. 

Sig.: A teaspoonful every two or three hours. (To allay the 
craving for alcohol.) — Loomis. 

{t Tincturae opii dedoratae gtt. xvj. 

Bismuth i subnitratis 3.ij. 

Syrupi simplicis 5iv. 

Aquae cinnamomi 5iss. — M. 

Sig.: Shake bottle. Give one teaspoonful every two to four 
hours. (For child one year old.) — J. Lewis Smith. 



104 A COMPENDIUM OF PRACTICAL MEDICINE. 

CHANCRE. 

I. Induration of Syphilitic Chancre. — Can always be felt 
when present, and in well marked cases it is absolutely pathogno- 
monic. It exists in three varieties : 1. A thin superficial layer 
of induration, aptly called "parchment-like," exactly underlying 
the ulceration. This is the commonest form. 2. The induration 
may resemble a split pea, situated exactly beneath the ulcer, 
which is upon its flat surface. This induration is easily felt, is 
little or not at all sensitive, freely movable over the parts 
beneath, hard like bone or wood, feels elastic, is sharply defined, 
ends abruptly. 3. The induration may be very extensive, far 
surpassing the bounds of the ulceration placed upon it, exca- 
vated or convex upon its surface. The skin over it is not usually 
red. Induration is usually greatest in chancres of the skin, lips, 
nipples, behind the corona glandis, and near the frgenum of the 
penis. In spongy tissue like the glans penis, the induration is 
often very slight. Again, when a syphilitic chancre becomes 
phagedenic, it loses its induration at once. The induration may 
precede the ulceration or follow it. In the latter case it comes 
on during the first week. Usually any form of induration will 
outlast the ulceration, remaining for two or three months, or 
more rarely for years. Bicord records one case of thirty years 
standing (Keyes). 

II. Ulceration of Syphilitic Chancre. — Properly, syphi- 
litic chancre does not ulcerate. It consists, in more than half the 
cases, simply of an excoriated surface, looking red and bloody, 
very superficial, frequently scabbed when exposed to the air. 
Indeed, it may never even excoriate, the lesion consisting in a 
simple indurated tubercle, which scales off a little at the top. 
But chancre of the genitals rarely escapes more or less inflam- 
mation, hence it is the rule to find some shallow, occasionally 
deep, ulceration. When shallow, the ulcer is round or oval, 
with slanting borders, often a red base. When deep, the borders 
are never abrupt, as in chancroid, but always sloped off. The 
cavity is funnel-shaped. Sometimes the induration left behind 
on the healing of a chancre re-ulcerates (Keyes). 



CHANCRE. 105 

III. Character of the Discharge. — Pus does not form as 
such on true syphilitic chancre, unless it be inflamed. Ordinarily 
the discharge is sero- purulent or purely serous, often bloody 
(Keyes). 

IV. Pain. — In unirritated syphilitic chancre, as a rule, 
there is absolutely no pain. A patient often carries a chancre 
some time without knowing it, and sometimes it comes and goes 
without being discovered at all. In this way may be explained 
many singular cases of undoubted syphilis, apparently not pre- 
ceded by any primary lesion (Keyes). 

V. Cicatrix. — The scar left by chancre varies. In a 
number of cases, there is no scar left behind. The scars left are 
at first discolored, of a dark, vinous hue, like the color of raw 
ham. This color may be followed by the true copper- colored. 
The scar is finally whiter in the center than the surrounding 
skin (Keyes). 

VI. Inoculation. — Auto-inoculations of chancre -secretion 
have been performed without number, the result having been 
invariably negative, unless the chancre had been previously irri- 
tated, or producing pus. Under such circumstances, the pustule 
and ulceration produced would be the same as the pus of any 
indifferent abscess would cause. The difference between the 
inoculation of chancroid and syphilitic chancre is illustrated in 
the famous case of Lindmann, who inoculated himself a number 
of times with chancroid pus, always with success, but with no 
syphilis; finally, believing himself protected (/. <*., syphilized), 
he inoculated himself with matter taken from the ulcerated 
tonsils of a syphilitic friend. This was followed on the eleventh 
day by a papule. The papule ulcerated slightly, and in forty- 
five days a general syphilitic eruption aj3peared. Lindmann 
inoculated himself twenty- seven hundred times with chancroid 
matter. Warnery, under the same "syphilization" delusion, 
inoculated himself many times with chancroid matter, which 
took, but produced only local ulcers. Finally he employed the 
syphilitic virus once, and an indurated chancre appeared, after 
twenty-seven days incubation, followed by syphilis in due course. 
Danielssen, a believer in " syphilization," inoculated a man, who 
had elephantiasis, two hundred and eighty-seven times with 



106 A COMPENDIUM OF PRACTICAL MEDICINE. 

chancroid; after this it would not take (i. e., he was " syphil- 
ized"). Now, one inoculation was made with true syphilitic 
virus. An indurated syphilitic chancre appeared, and in sixty- 
eight days a general syphilitic eruption followed (Keyes). The 
course of syphilitic chancre observed by hetero- inoculation is as 
follows : u There may be a pustule which soon heals. No change 
occurs for a period varying from ten to thirty- nine clays; then 
the first signs of chancre appear, not as in chancroid by a 
pustule, but as an indurated papule of a dark color without 
pain, followed by syphilis. 

There is one source of error in regard to vaccinal syphilis ; 
namely, that the vaccinal fever may develop latent, possibly un- 
suspected syphilis from which a child is already suffering by 
inheritance, or previous contagion. Here the vaccination will 
always be accused of being the cause of syphilis. The distinc- 
tion is easy. If vaccination develops latent syphilis, it does so 
as a blister would, and a general eruption comes on quickly; 
whereas in true vaccinal syphilis, there is first a period of incuba- 
tion, then a local chancre, then indurated glands, and after a 
second incubation, a general syphilitic eruption (Keyes). 

VII. Duration of Syphilitic Chancre. — Is from two weeks 
to several months. In about fifty per cent, of the cases a general 
syphilitic eruption appears before the chancre has cicatrized. 

VIII. Number. — Syphilitic chancre is most often unique, 
because commonly only one point is inoculated. When multiple, 
however, it is usually so from the first, because its secretion is 
not auto-inoculable. 

IX. Size. — Syphilitic chancre may occasionally reach a 
large size, as large as a quarter or a half dollar. This is, how- 
ever, exceedingly rare. It is often as small as a split pea and 
sometimes smaller. In size and general appearance it compares 
unfavorably with its more formidable-looking rival, chancroid. 

X. Situation. — Syphilitic chancre occurs indifferently on 
all points of the body. No regions are exempt from it. Syph- 
ilitic chancres of the head, face and breast are common, and reach 
their full size. Chancre of the lip is particularly prominent, 
large, hard, and chronic in its course. The genitals are the 
favorite seat, because they are most often exposed. Urethral 



CHANCRE. 107 

chancre is not very common. It may simulate gonorrhoea in its 
discharge, but when the eruption appears, the diagnosis will he 
easy. 

XI. Form of Syphilitic Chcmcre. — Syphilitic chancre 
appears after an incubation of not less than ten days, usually not 
till the end of three weeks, as a reddened spot, which quickly 
excoriates ; or as an elevated papule, which excoriates or ulcer- 
ates. It may take any one of four forms, in the following order 
of frequency: 1. Erosion. 2. Ulceration. 3. Deep ulceration, 
funnel shaped (Hunterian chancre). 4. Indurated papule, which 
remains dry. Erosion is believed to include two -thirds of all 
syphilitic chancres. It is very common inside of the prepuce. 
It discharges serum and not pus. The indurated papule, which 
does not ulcerate, is found sometimes on the skin after inocula- 
tion, and even on the mucous layer of the prepuce. The color 
of these papules is a dark vinous red. The course of all the 
above chancres is about the same. Chancre uninilamed and 
unirritated is painless (Keyes). 

XII Complications of SyphiUtie Chancre: Are (#) veg- 
etations; (b) inf animation; (c) chancroid, mixed chancre; (77) 
transformation into mucous patch; (<?) phagedena and gan- 
grene ; (/) syphilitic bubo; (7/) lymphangitis. — (a) Vegeta- 
tions: Warty growths are liable to spring up around syphilitic 
chancre of the prepuce or anus, as they are with other forms of 
irritative disease (chancroid, balanitis, gonorrhoea). These are 
rare and purely accidental. Syphilis as a poison has nothing to do 
with their production, (c) Chancroid may complicate syphilitic 
chancre and produce a "mixed sore." This sore will have the 
characters and qualities of both lesions. For syphilitic bubo, 
as a complication, see Bubo. Syphilitic Lymphangitis is a spe- 
cific induration of the lymph vessels and surrounding cellular 
tissue. Hard, smooth and knotty cords, varying from the size 
of a knitting-needle to that of a goose -quill, can be felt under 
the skin of the penis. They are not sensitive to pressure, and 
the skin over them is not red. Starting in the induration of the 
chancre, they often do not reach to the root of the penis. There 
may be one or more of these cords on one or both sides of the 
penis. It occurs in about twenty per cent of cases. 



108 A COMPENDIUM OF PRACTICAL MEDICINE. 

XIII. Differential Diagnosis of (1) Syphilitic Chancre; 
(£) Chancroid ; (5) Herpes, and (4) Ulcerated Abrasions. — 
1. Nature. Of 1, always a constitutional affection. Of 2, always 
a local disease. Of 3 and 4, local. 2. Cause. Of 1, sexnal inter- 
course with a patient suffering from syphilitic chancre, or some 
secondary syphilitic lesion of or near the genitals, vaccination 
with syphilitic blood, accidental inoculation of any vehicle con- 
taining the syphilitic virus upon an abrasion of any portion of 
the body. Of 2, sexual intercourse with a patient suffering from 
chancroid of or near the genitals, accidental or designed inocu- 
lation with the secretion of chancroid. Of 3 and 4, mechanical 
and chemical irritation. 3. Situation. Of the 1, usually upon 
or near the genitals, frequent on the head, hands or nipple. Of 
the 2, very rare except on or around the genitals. Of the 3 and 
4, upon the genitals. 4. Incubation. Of the first, constant, not 
less than ten days, usually three weeks. Of the 2, none after 
the absorption of the poison. Ulcer usually fully formed on the 
second or third day; very rarely commences later than the sev- 
enth. Of the 3 and 4, none. 5. Commencement. Of the 1, 
begins as an erosion or a papule, and remains an erosion or 
ulcerates. Of the 2, begins as a pustule or ulcer, and invariably 
remains as an ulcer. Of the 3, begins as a group of vesicles, 
and remains as an ulcer. Of the 4, begins as an abrasion or 
fissure, and remains as an ulcer. 6. Number. Of the 1, usually 
unique. Of the 2, usually multiple. Of the 3 and 4, generally 
multiple. 7. lesion. Of the 1, habitually flat, or scooped out, 
or deep funnel shaped, or dry papule. Of the 2, always true 
ulcer, excavated, hollowed out. Of the 3, ulcer superficial. 8. 
Edges. Of the 1, sloping and adherent, sometimes prominently 
elevated. Of the 2, sharply cut, abrupt, often undermined. 9. 
Bottom. Of the 1, smooth, shining. Of the 2, uneven, warty, 
irregular, without luster. 10. Color. Of the 1, darkish red, gray 
or black. Of the 2, yellow, tawney, false -membranous looking. 
11. Secretion. Of the 1, slight sero-sanguinolent. Of the 2, 
abundant and purulent. 12. History. Of the 1, not found on 
persons who have had syphilis. Of the 2, found indifferently 
upon all. Of the 3 and 4, found on patients with long and 
tight prepuce and uncleanliness. 13. Inoculability . Of the 1, 



CHAKCRE. 109 

not auto-inoculable. Of the 2, readily auto-inoculable produc- 
ing a characteristic chancroid ulcer by the first day. 14. Course. 
Of the 1, slowly progressive. Of the 2, rapidly progressive. Of 
the 3 and 4, do not usually tend to get much . larger than the 
size at which they started. 15. SensibilMy. Of the 1, rarely 
painful. Of the 2, often painful. Of the 3 and 4, usually painful. 

16. Induration. Of the 1, constant, parchment -like, terminating 
abruptly, insensitive to pressure, movable upon the parts be- 
neath the skin, may remain a few days or for years. Of the 2, 
absent in typical cases. When present, is sensitive to pressure, 
shades off into surrounding tissues, is adherent to parts around. 

17. Bubo. Of the 1, is constant. Of the 2, in two-thirds of the 
cases glands are unaffected. Of the 3 and 4, rare. 18. 
Prognosis. Of the 1, good for local consequences, but syphilis 
follows. Of the 2, no after affects. Of the 3 and 4, good. 19. 
Treatment. Of the 1, local treatment but slightly effective. Of 
the 2, local treatment curative. Of the 3 and 4, local treatment 
curative (Keyes). 

Treatment of Syphilitic Chancre. — No amount of cauterization 
nor any local treatment can prevent the development of general 
syphilis after the poison has once been absorbed, much less after 
the chancre has appeared. Excision of the primary lesion does 
no good. The best local treatment consists in the use of dry 
lint, sprinkling with iodoform, or calomel, or the use of black or 
yellow wash. The internal treatment of syphilitic chancre is 
the same as that of early syphilis. Where there is the least 
shadow of a doubt, as to the diagnosis, no mercury should on 
any account be given until an eruption has appeared (Keyes ). 

PRESCRIPTIONS FOR CHANCRE. 

R Hydrargyri chloridi mitis gr. xv. 

Liquoris calcis gij. — M. 

Sig. : Shake and apply as a wash. (Black wash.) — Bartholow. 

R Hydrargyri chloridi corrosivi gr. j. 

Liquoris calcis ,?viij. M. 

Sig.: Shake and apply on lint. (Yellow wash.) — Little. 

R Hydrargyri chloridi mitis o$s. 

Sig. : Dust on and cover with dry lint. — Van Buren and Keyes. 



110 A COMPENDIUM OF PRACTICAL MEDICINE. 

R Iodoformi 

Ly copodii — aa oiij • — M. 

Sig. : Dust on and cover with dry lint. — Sturgis. 

CHANCROID. 

Is a local, virulent, contagious venereal ulcer, never the 
starting point of syphilis. Its own secretions are freely auto- 
inoculable. 

Of the three distinct venereal diseases, gonorrhoea, chancroid 
and syphilis — gonorrhoea is, strictly speaking, the most venereal, 
being practically never acquired except in sexual intercourse. 
Chancroid, equally virulent, is less venereal, and recognizes many 
methods of propagation besides sexual congress. While syphilis 
is of all the least virulent, and the least venereal. Nothing can 
produce chancroid except chancroid (Keyes). 

Cause. — It can be produced only by the contact of pus from 
a similar ulcer upon some portion of the skin or mucous mem- 
brane under conditions favorable for absorption. No one is 
exempt. The bearer of a chancroid is just as liable to be pois- 
oned by the pus of his own sore as is a perfectly healthy person. 
Lindmann inoculated himself 2,700 times. Hence the rule, an 
individual may have chancroid as often as he is exposed ; there 
is no limit to the number of possible attacks (Keyes). 

Frequency of Chancroid. — Statistics show that in dispen- 
saries and hospitals, among the poor and dirty, the frequency of 
chancroid far outranks that of true syphilitic chancre, while in 
the higher walks of life true syphilitic chancre is more common 
than chancroid. The poor consort with the lower orders of 
prostitutes who have old chronic chancroid, which forms a hot- 
bed of infection for all who approach. Finally, syjDhilitic chancre 
occurs but once in a lifetime, and rarely lasts long ; while chan- 
croid may be acquired an indefinite number of times. 

Methods of Contagion. — By direct contact, as in sexual in- 
tercourse, or manipulation of chancroids with fissures or abras- 
ions on the hand, or through some intervening agency. 

Situation of Chancroid. — It is rarely found far from the 
genitals. In the male by preference it is found in the sulcus on 
either side of the frsenum. 



CHANCROID. Ill 

Symptoms. — Chancroid has no period of incubation or 
hatching. When the virus is placed in a position where absorp- 
tion is possible, it commences its work at once, and rapidly 
reaches the stage of ulceration. Usually by the third day after 
suspicious intercourse, occasionally as late as a week, a small 
ulcer will be found. It increases in size for one or two weeks, 
and remains stationary for perhaps two weeks, and then repair is 
announced by a more creamy, laudable pus. Chancroid is usu- 
ally round or oval in shape. In number it may be unique, or 
any given number may co- exist. In size, it varies from that of 
the head of a pin to a large surface. 

Duration. — A chancroid untreated never lasts less than a 
month, and may last months, or even years. 

Pain. — Chancroid may be almost entirely painless, but 
clinically, pain is usually a diagnostic symptom of chancroid, 
serving to distinguish it from syphilitic chancre. 

Induration. — There is no induration unless the chancroid is 
irritated, and then it is an inflammatory hardness. 

Helapse.—A chancroid may be almost repaired, when it 
suddenly reinfects itself. A relapse may occur a second or even 
a third time. 

Complications of Chancroid. — Inflammations, vegetations, 
jDhimosis, paraphimosis, lymphangitis, erysipelas, gangrene, pha- 
gedena, simple bubo, and virulent bubo may complicate chan- 
croid. 

Treatment. — Abortive. All the stronger mineral and some of 
the vegetable acids, and caustic alkalies, prevent the development 
of the chancroid if applied over the inoculated point for a con- 
siderable time — about two hours— within a period of three to 
twenty-four hours after inoculation. When the chancroid is 
once present, active caustics, such as nitric and sulphuric acids, 
and the actual cautery may be used. Burn every portion of 
every ulcer, no matter what its size. In applying nitric acid it 
is well to use a rather blunt glass rod. The ulcer should be 
thoroughly cleaned and dried with blotting paper slips. A drop 
of pure carbolic acid applied and then absorbed out with blot- 
ting paper makes the acid application less painful. Now the 
nitric acid is thoroughly applied and left on until a white rim of 



112 A COMPENDIUM OF PRACTICAL MEDICINE. 

dead tissue announces that the base of the ulcer is destroyed. 
Now the nitric acid is dried up with blotting paper slips and the 
surface touched with liquor potassae to neutralize any excess of 
acid there may be. The burned surface is dressed dry with a 
little absorbent cotton. The eschar separates in a few days, 
leaving a healthy ulcer which heals under a dry dressing. In 
cauterizing a chancroid under a tight prepuce, inflammatory phi- 
mosis may come on unless the patient be kept at rest after the 
cauterization. In using the actual cautery, the point should be 
carried down into every portion of the ulcer until a black dead 
eschar of the whole surface is produced. Cold-water dressing is 
applied afterward and anodyne given until pain has ceased. 
Apply a strong solution of cocaine before burning. If the ulcer 
has lasted only a few days, one thorough cauterization cures it. 
If the ulcer is already several weeks old, it will in many instances 
get well as quickly under iodoform, calomel, or other dressing as 
it will by being cauterized. Nitrate of silver does harm, since 
its caustic action does not extend deep enough, and superficial 
cauterization always makes matters worse. It is well to remem- 
ber that greasy local applications to chancroids are bad. When 
it is not advisable to use caustics, cover the entire surface with 
iodoform powder. Cleanliness is of the first importance. Dusting 
the surface with calomel and bismuth is a good expedient 
(Keyes). 

PRESCRIPTIONS FOR CHANCROID. 

R Iodoformi gij. 

Sig. : Dust on sore and cover with lint dipped in glycerine. 

— Ringer. 

R Bismulhi subiodidi ^iv. 

Sig.: Dust. on sore and use dry dressings. 

R Pulveris acidi salicylici gij. 

Sig.: Dust on sore and cover with dry dressing. — Auglada. 

CHILBLAINS. 

Are local inflammations of the skin, and are to be met with 
in subjects of a feeble circulation. They are more common in 
the young and in women than in men, and are generally seen on 



CHILBLAINS CHLOROSIS. 113 

the toes, fingers, nose or ears, and are caused by any sudden 
change of temperature, or any sudden application of cold or 
warmth. Chilblains may show themselves as simple congestions 
of the skin, attended with tenderness or itching; or when the 
inflammation is more severe, vesication, or when a broken chil- 
blain occurs, sloughing and ulceration. Any external warmth 
or anything that excites the circulation in the part is apt to in- 
crease the symptoms. 

Treatment. — General: Tonics, good diet, external warmth 
and exercise. Locert: When the chilblain is not broken, the 
local application of the tincture of iodine, of camphor liniment, 
of soaj3 liniment with opium, or of simple spirit, not only gives 
comfort, but hastens the cure of the disease. Turpentine and 
carbolic acid are most highly recommended. When the parts are 
broken, vaseline, and boracic acid ointment are the safest 
remedies. 

PRESCRIPTIONS FOR CHILBLAINS. 

R Acidi carbolici gr. x. 

Cosmolini 

Olei terebinthinae aa gj. — M. 

Sig. : Apply to the aftected part. — Davidson. 

R Linimenti chloroformi ^ij. 

Sig.: Apply to part with gentle friction. (Early stage). 

— Davidson. 

R Tincturae iodi 5J. 

Sig.: Apply to parts with brush. (When swollen or granu- 
lated). — Davidson. 

CHLOROSIS. 

Is an anaemia occurring in girls about the period of puberty. 
The term chlorosis relates to the peculiar tint the complexion 
assumes in this disease, and in common language is called 
" green- sickness " (Bartholow). 

Cause. — Chlorosis is regarded by some as a neurosis, the 
blood changes being secondary to the neurosis. There is nearly 
always some functional derangement of the sexual organs. Self- 
pollution is claimed as an exciting cause of chlorosis. The 
patient is usually light, fair, full, round, but white, having blue 



114 A COMPENDIUM OF PRACTICAL MEDICINE. 

eyes, soft tissues and feeble muscles. Heredity may exist 
(Loomis). 

Symptoms. — The patient becomes despondent or morose. 
The countenance assumes a peculiar waxy, yellow, or yellow- 
green pallor. The face is puffy, the eyes are surrounded by 
deep, blackish circles, and the mucous membranes are pale. 
There are muscular weakness, dyspnoea, and fits of cardiac palpita- 
tion are common. The appetite is capricious. The patient will 
eat with avidity chalk, slate pencils, ashes, dirt, or strongly acid 
and spiced food. Cardialgia is a common symptom, and belch- 
ing of gas. There may be nervousness, dry cough, etc. (Flint, 
Loomis and Bartholow). 

Differential Diagnosis. — Chlorosis may be confounded with 
simple anaemia, Bright 1 s and cardiac disease. In anaemia emacia- 
tion is marked; in chlorosis there is no loss of flesh. The pecu- 
liar greenish color and the mental state, the age and sex and 
uterine derangement will distinguish it. The examination of the 
urine in Bright's, and of the chest in cardiac disease will decide 
the question (Loomis). 

Prognosis. — Its duration is very uncertain. It is not a self- 
limited disease, and manifests no tendency to spontaneous cure. 
As a rule the prognosis is very unfavorable, on account of com- 
plications such as phthisis, valvular endocarditis, and gastric 
ulcer (Loomis). 

Treatment. — Patients should have an out-of-door life with 
cheerful companions and surroundings. The combinations of 
iron with a mineral acid are usually effective. According to 
Bartholow the combination of iron with arsenic is best. Strych- 
nia and the lacto- phosphate of lime are useful. Best, forced 
feeding, massage and faradization are advocated by Weir 
Mitchell. 

PRESCRIPTIONS FOR CHLOROSIS. 

R Tincturse ferri muriatic giv. 

Acidi phosphorici diluti £vj. 

Spiritus limonis ^ij . 

Syrupi q. s., add jfvj. — M. 

Sig. : A dessertspoonful in water after meals. — Goodell. 



CHLOROSIS CHOLEEA MORBUS. 115 

R Hydrargyri chloridi corrosivi gr. j-ij. 

Liquoris arsenici chloridi 3J. 

Tincturse ferri chloridi giv. 

Acidi hydrochlorici diluti ^iv. 

Syrupi giij. 

Aquas ad § vj . — M. 

Sig. : A dessertspoonful in a wineglass of water after meals. 

— Smith. 

R Quinina? sulphatis gr. xx. 

Ferri sulph. exsiccat gr. xL. 

Strychnise sulphatis gr. ss. — M. 

Ft. massa et in pilulas no. xx. div. 
Sig.: One pill thrice daily. — Bartholow. 

CHOLERA MORBUS. 

Called, also, cholera nostras, English cholera, and sporadic 
cholera, is an acute catarrh of the stomach and intestines, of 
sudden onset, and manifested objectively by vomiting and purg- 
ing. 

Causes. — Cholera morbus almost always occurs in July and 
August. Sudden checking of the perspiration, or suddenly 
chilling the surface of the body by external cold, or iced drinks, 
and sudden changes in the temperature after a heated term will 
produce it. Its most frequent cause is undigested food, as shell- 
fish, unripe fruit, cucumbers, etc (Looniis). 

Symptoms. — An attack usually begins at night by vomiting 
and purging. The matters vomited are, first, undigested food, 
gastric mucous and bile. The vomiting is projectile in character, 
and there is temporary relief after each attack. The bitter fluid 
leaves a burning sensation in the mouth and throat. Thirst is 
intense. The evacuations from the bowels are watery and pro- 
fuse, and have a mouse-like odor. In some cases purging alone 
is present. There is intestinal colic. In all severe cases there 
are cramps in the lower extremities, especially in the calves of 
the legs and feet. The skin is cold, and covered with a pro- 
fuse perspiration. Sometimes the abdominal muscles are knotted 
by cramps (Loomis). 

Prognosis. — Cholera morbus is rarely a fatal disease. The 
duration is from a few hours to two days, and in the rare eases 



116 A COMPENDIUM OF PRACTICAL MEDICINE. 

of secondary fever, to two weeks. When the patient passes 
into the stage of collapse, there is always danger (Loomis). 

Treatment. — In mild cases ice may be given to check the 
vomiting, and sinapisms applied to the epigastrium. In severe 
cases give morphine hypodermically, and apply dry heat to the 
extremeties. From two to five drops of diluted sulphuric acid, 
or the same dose of muriatic acid diluted, and the same quantity 
of tincture of opium should be given from every half hour to 
every two hours, in a sufficient quantity of ice- water. Carbolic 
acid alone or in mixture with bismuth, is an efficient means for 
arresting vomiting; besides, its properties as an anti- ferment, it 
has a local anaesthetic action on the terminal filaments of the 
nerves in the mucous membrane. One-twelfth to one-sixth of a 
grain of calomel will relieve the vomiting and purging. Chloro- 
dyne is very effective (Bartholow). 

PRESCRIPTIONS FOR CHOLERA MORBUS. 

R Acidi nitrosi 3j. 

Tincturae opii gtt, xL. 

Aquae cam phorae £ viij . — M. 

Sig. : One-fourth part to be taken every three or four hours. 

— Hope. 

R Tincturae opii 

Tincturse capsici 

Tincturae rhei aromatici 

Spiritus menthae piperitae 

Spiritus camphorae aa giss. — M. 

Sig.: Twenty to^forty minims, diluted. — Ruschenberger.. 

R Strychniae sulphatis gr. \. 

Acidi sulphurici diluti ^ss. 

Morphinae sulphatis gr. ij. 

Aquae camphorae q. s., ad 5iv. — M. 

Sig.: A teaspoonful every hour or two well diluted. (In threat- 
ened collapse.) — Bartholow. 

CHOLERA INFANTUM. 

Called also "summer complaint;" is an acute gastrointes- 
tinal catarrh, occurring in children during the period of the first 
dentition, and characterized by vomiting, purging and fever 
(Bartholow). 



CHOLEEA INFANTUM. 117 

Causes. — Early life — the first two years — is tlie period for 
cholera infantum. Bad hygiene is the great factor, including 
damp, ill -ventilated and confined houses, continuous high tem- 
perature, and improper food. Feeding infants the coarse food 
of adults, containing much starch, and artificially fed chil- 
dren, are most fruitful causes. It prevails more in cities than in 
"the country (Bartholow). 

Symptoms. — It begins either with vomiting or diarrhoea or 
both. The child rejects all food, and becomes peevish. Purging 
is always present, and the passages are watery and greenish in 
color, and contain curdy masses mixed with mucus. The dis- 
charges are more or less slimy, sometimes frothy, and at first 
have a distinctly sourish odor. The child is constantly thirsty, 
and becomes stupid. The temperature is rarely above the 
normal. The number of passages varies from six to seventy- five 
in twenty- four hours. The abdomen at first may be distended, 
but later it is retracted and always tender. The disease usually 
lasts a week (Loomis). 

Prognosis. — In severe cases, unfavorable. 

Treatment. — In the treatment, fresh air is very important. 
Fresh cow's milk with barley and lime-water added is the best 
artificial diet ; but a good wet nurse is always to be preferred. 
To relieve the intense thirst, the child may suck pounded ice in 
a linen bag. The only drug that Loomis has found efficacious 
in controlling the vomiting is calomel, which should be given 
dry on the tongue in minute doses, iV of a grain every half hour. 
Bismuth and carbolic acid are very useful ; and salicylic acid is 
also of value in arresting fermentation. For the diarrhoea, give 
iixe or ten drops of the camphorated tincture of opium, every 
two hours. Camphor and brandy may be given for the purging. 
The vegetable astringents, such as hgematoxylon, kino, and 
catechu are of service in controlling the diarrhoea. Flannels 
should be worn next the surface during convalescence (Loomis). 
According to Bartholow, a most efficient prescription is the com- 
bination of bismuth and carbolic acid — ten grains of the former 
and one-fourth to one-half grain of the latter, every two hours. 



118 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR CHOLERA INFANTUM. 

R Hydrargyri chloridi mitis ..gr. iij. 

Cretse prsep gr. xxxvi. 

Plumbi acetatis gr. xij. 

Pulveris ipecac gr. iij. — M. 

In chart, no. xii. div. 
Sig. : One every three hours. — CondiL 

R Oleiricini 3ij. 

Pulveris acacia 

Sacchari albi — aa ^ij. 

Tincturse opii ZHxxi. 

Aquae cinnamomi — q. s ad. ^iv. — M. 

Sig. : A teaspoonful every two or three hours. — West. 

R Hydrargyri cum cretse gr. ij. 

Sacchari lactis gr. x. — M. 

In pulv. no. xii. div. 
Sig. : A powder every hour. — Ringer. 

R Potassii bromidi 3Jj. 

Syrupi simplicis ^ss. 

Aquae menthse piperita? ^iss. — M. 

Sig.: A teaspoonful every hour or two (when cerebral conges- 
tion). — Bartholow. 

R Tincturse opii deodorat , gtt. xvj. 

Spiritus amnion, aromat 3J. 

Bismuthi subnitratis 31J. 

Syrupi simplicis gi v. 

Misturse cretse giss. — M. 

Sig.: Shake well and give a teaspoonful every two or three hours 
to a child 8 to 12 months old. — J. Lewis Smith. 

CHORDEE. 

Is a gonorrhoeal, painful, down- curved erection. 

Causes. — When the inflammation is severe, and has extended 
from the mucous membrane into the delicate meshes of the 
erectile tissue of the corpus spongiosum, the erections are 
painful. In this condition the corpus spongiosum does not allow 
complete distention of its areolae, and hence the urethra is com- 
paratively too short for the erect corpora cavernosa and bends 
the penis downward like a bow during erection. If the corpora 



CHORDEE. 119 

cavernosa should become inflamed and the corpus spongiosum 
escape, the arching would be in the opposite direction. 

In chordee, great pain is felt from the stretching of the in- 
flamed erectile tissue. This pain is measurably relieved by 
bending the penis so as to increase the bow. Chordee is most 
frequent during the night and toward morning. 

The pernicious practice of " breaking the chordee," which 
consists in roughly straightening the penis when erect, gives rise 
to a haemorrhage which may become excessive, and be the start- 
ing point of organic stricture. 

. Treatment. — The best course is for the patient to keep his 
urine dilute and alkaline, avoid lascivious thoughts, and resort 
to prolonged immersions of the j3enis in very hot water before 
retiring. He should sleep lightly covered, on his side, on a hard 
bed, after a small evening meal, in a cool room. Bromide of 
potassium, in doses of from thirty to sixty grains at night in 
water, repeated once if necessary, will control chordee in some 
cases. In other cases morphine is the best. When a patient 
wakes with chordee, the penis should be plunged into the coldest 
water which is at hand, or what is better, if it is winter, laid 
along a piece of iron, or other metal which has been exposed to 
the cold. Lupulin in doses of from thirty to sixty grains in 
powder with sugar, is of undoubted service in chordee. 

PRESCRIPTIONS FOR CHORDEE. 

R Extracti opii aquos , gr. iss- 

Olei theobromae gr. xxx. — M. 

Ft. suppositor no. 1. 
Sig. : Introduce into the rectum on retiring. 

— VanBuren and Ke} r es. 

R Spiritus camphorae §j 

Sig.: One teaspoonful at bed time in water. — Milton. 

R Potassii bromidi gr. xv.-xx. 

Chloral hydratis gr. v. 

Spiritus vini gallici ^ij. 

Spiritus camphors 211.x. 

Aquae menthae piperita gj. — M. 

Sig.: Give at bed time. — Milton. 



120 A COMPENDIUM OF PRACTICAL MEDICINE. 

R Extracti opii aquos gr. ij. 

Pulveris camphorse.. gr. iv. — M. 

In pil. no. ii. div. 
Sig. : One or both on retiring. — VanBuren and Keyes. 

CHOREA. 

Called also St. Vitus's or St. Guy's dance, is a disease of the 
nervous system, which is characterized by irregular and invol- 
untary muscular movements, without loss of consciousness 
(Smith). 

Age. — Chorea may occur at any period of life, but a large 
majority of the cases are in childhood. The maximum frequency 
of chorea is between the sixth and tenth years. 

Causes. — All writers admit that there is often an inherited 
predisposition to chorea. The disease usually makes its appear- 
ance about 'the second dentition, or at puberty. Rheumatism, 
intestinal worms, sexual abuses,- amenorrhcea, anaemia, and strong 
moral emotions, are frequent exciting causes. Fright, shock, 
and extreme mental labor or any form of severe nervous disturb- 
ance may act as an exciting cause. It may be produced by un- 
conscious imitation, as has been shown in schools. Girls are 
more liable to it than boys. Dysmenorrhcea and pregnancy are 
causes (Smith, Flint, and Loomis). 

Symptoms. — Chorea is partial or general. It is partial when 
it affects a few muscles or groups of muscles; general when all 
the muscles are involved. Speech may be impaired or lost. Loco- 
motion may be impossible. The movements of chorea are in- 
creased when the patient is conscious of being observed, and 
under any emotional excitement, and are usually on the left side. 
The affection is not accompanied by fever. Anaemia often co- 
exists. Irritability of temper is a notable feature. The mental 
faculties are weakened. The affection usually comes on gradu- 
ally. Tenderness of the spine is a constant symptom. In the 
severest cases sleep is disturbed. The duration varies from a 
few weeks to several months; the average is between two and 
three months (Smith, Flint and Loomis). 

Prognosis. — Complete recovery is the rule, but relapses fre- 
quently occur. 



CHOREA COLIC. 121 

Treatment. — A number of remedies have been advocated as 
affecting a cure of this disease. In general, Avhen different 
methods of treatment of any disease are found to be successful, 
it is a fair inference that the disease ends favorably from an in- 
trinsic tendency (Flint). If there be rheumatism, anaemia, and 
constipation, each one demands its appropriate treatment. 
F owlets solution, in doses of three or four drops three times 
daily, is very efficacious. Iron, zinc, strychnia, opium and cannabis 
indica are useful. The application of the ether spray to the 
spine for four or five minutes at a time daily or on alternate 
days has been found efficacious. Children with chorea should 
not go to school. Excellent results have been obtained by con- 
finement to bed in a darkened and quiet room, and a careful but 
generous diet (Bartholow). Morphine and chloral may be given 
to produce sleep. Galvanization and faradization are service- 
able. Cod- liver oil and the hypophosphates are useful remedies. 
The iodide of iron is good in some cases (Smith, Flint, and 
Bartholow). 

PRESCRIPTIONS FOR CHOREA. 

R Chloral hydratis gvj.-viij. 

Syrnpi aurantii cort 5iij. — M. 

Sig. : A teaspoonful three times daily for one or two months. 
(Child ten years old.) — Joffrey. 

R Eserinae sulphatis gr. j. 

Aqua? destillatse gvj . — M. 

Sig.: Six minims hypodermically twice daily, with tonics. 

- — Riess. 

COLIC. (Intestinal.) 

Includes all painful affections of the intestines which are 
not caused by structural changes in the intestinal wall (Loomis). 

Its varieties are flatulent, bilious, lead, copper, gouty, arid 
rheumatic colic. It is a purely functional affection, and is 
attended by irregular spasmodic contractions of the muscular 
coat of the intestine. 

Causes. — It occurs most frequently in the young. Neurotic 
temperaments and a sedentary mode of life, rheumatism, chronic 



122 A COMPENDIUM OF PRACTICAL MEDICINE. 

alcoholismus and gout predispose to it. Malaria, syphilis and 
liver derangements may produce it. Cold feet is often its excit- 
ing cause. Direct irritation of the bowels by undigested food, 
certain articles of food, as cucumbers, shell- fish, strawberries, 
etc., will cause colic in some persons. Gaseous collections and 
distention of the intestine by faeces, or by bundles of worms, 
sometimes excite it. Lead and copper cause colic (Loomis). 

Symptoms. — The attack itself comes on suddenly. In flatu- 
lent colic, there is a severe twisting, paroxysmal pain around the 
umbilicus, or in the region of the colon. The abdomen becomes 
distended with the flatus, the bowels are constipated, eructations 
and borborygmi are present, and there may be vomiting. Steady 
pressure over the abdomen relieves the pain. There is no rise 
of temperature, the surface, if the pain is severe, is cold and cov- 
ered with clammy perspiration. On palpation during a spasm, 
the intestine at points may be felt rigid and hard. Flatulent 
colic is often called crapulous, when it follows a too hearty meal, 
or the food indigestible. Crapulous colic is accompanied by 
pains in the head and dimness of sight, sometimes by uticaria 
and roseola. Flatulent colic is most frequently met with in 
infants. Bilious colic is accompanied by nausea and vomiting, 
the vomited matters being greenish and yellow. It is preceded 
by nausea, anorexia, and a coated tongue. It sometimes begins 
with a chill. The bowels are obstinately constipated. Bilious 
colic occurs in summer and autumn. Lead colic, or colica pic- 
tonum, comes on with moderately severe paroxysms of pain. 
The pain is located about the umbilicus, and is twisting or 
grinding in character. The abdomen is contracted and hard; 
knots of rigid intestine can sometimes be felt, and pressure 
somewhat relieves the pain. An individual suffering from lead 
poison is sallow, anaemic, and often the extensors of the forearm 
are paralyzed, and along the edge of the gums is a deep blue 
dotted line composed of lead. 

Prognosis. — Is always favorable. 

Treatment. — Will depend upon the cause. Usually purga- 
tives are indicated. In all forms opium, chloroform, hydrate of 
chloral or ether may be given to relieve the pain and spasm. In 
hysterical and nervous subjects, at the outset of the attack, 



COLIC CONDYLOMATA. 123 

Hoffman's anodyne, asafcetida, valerian and the essential oils 
often quickly relieve the pain and remove the flatus. In child- 
ren, bromide of potassium in carminative waters often affords 
speedy relief. Gouty colic is best treated with oil of cajuput, and 
carminatives. The feet are to be placed in a mustard bath, and a 
mustard plaster is to be placed on the abdomen. In lead colic, 
opium is the most efficient remedy. It will often relieve the 
constipation. A milk diet acts as a prophylactic and curative 
agent (Loomis). Twenty drops of chloroform, repeated, if 
necessary, at short intervals will sometimes afford prompt relief 
in severe cases. 

PRESCRIPTIONS FOR COLIC. 

R Syrup i rhei aromatici 

Tincturse opii camphoratse 

Tincturse cardamon comp 

Aquae cinnamomi aa gj . — M. 

Sig. : Two to four teaspoonsful. (For crapulent colic.) 

— Hartshorne. 

R Magnesii carbonatis gr. xl. 

Sacchari albi , ^iss. 

Tincturse asafcetidse £iss. 

Tincturse opii gss. 

Aquse ^iss.— M. 

Sig.: Five to sixty drops, according to age. (In infantile colic.) 

— Dewees. 
R Spiritus chloroformi 

Tincturae cardamonii aa ^ij. — M. 

Sig.: A teaspoonful every half hour till relieved. — Bartholow. 

R Tincturse opii deodorat gtt. xii. 

Magnesii calcinat err. xii-xxiv. 

Sacchari albi gj. 

Aquae anisi 3iss. — M. 

Sig.: Shake well. One teaspoonful to a child one year old. 

—J. L. Smith. 

CONDYLOMATA. 

Are fleshy, syphilitic excrescences about the anus or peden- 
dum. They must not be mistaken for warty excrescences, or 
vegetations, which, although common in syphilitic subjects, have 
nothing specific about them. Vegetations or warty growths arc 



124 A COMPENDIUM OF PRACTICAL MEDICINE. 

liable to spring up around syphilitic chancre of the prepuce or 
anus, as they are with chancroid, balanitis, gonorrhoea, or any 
irritation. They are purely accidental. Syphilis, as a poison, 
has nothing to do with their production. Vegetations upon the 
penis are commonly called venereal warts; but as they are noth- 
ing more than papillary overgrowths, caused by irritating fluids, 
or simply by lack of cleanliness, the title is not exact. They 
are not influenced like condylomata, by anti- syphilitic treatment, 
and are often cured by mere attention to cleanliness. There is a 
contagious element about warts (Keyes). In children they seem 
to come from irritation of worms (Bryant). 

PRESCRIPTIONS FOR CONDYLOMATA AND WARTS. 

Jfc Acidi nitrici §j. 

Aquae 0. j. — M. 

Sig.: Use frequently as a wash. — Ringer. 

Jt Acidi chromici gr. c. 

Aquae destillat&e gj. — M. 

Sig. : Apply locally with match or glass rod. — Bartholow. 

Jfc Hydrargyri chloridi corrosivi gr. x. 

Collodii zv— M. 

Sig.: Paint the wart once daily. — Kaposi. 

|& Acidi nitrici gss. 

Sig.: Apply to wart with match three or four times a week. 

CONJUNCTIVITIS. 

Is an inflammation of the conjunctiva. There are several 
varieties, but the most common forms which the general prac- 
titioner will meet, are hyperemia palpebralis, and simple or 
catarrhal conjunctivitis. 

Causes. — Nasal catarrh, various forms of eye- strain, "hay 
fever" or "rose cold." Whatever makes vision difficult excites 
this hyperemia. We see it in those who use their eyes to ex- 
cess; in those who have wept extremely; in those who have 
errors of refraction, and in those who work in dust. The causes 
of simple or catarrhal conjunctivitis are atmospheric, ill-ventil- 
ated rooms, exposure to dust, smoke and heat. It is apt to 



CONJUNCTIVITIS CONSTIPATION. 125 

occur at the seaside in summer, from heat, glare and dampness. 
Workers at the forge, millers, cigar -makers and moulders are its 
special subjects. It occurs as a symptom in coryza, measles, 
scarlatina, variola and varicella -(Noyes). 

Symptoms. — The symptoms are worse at night and are 
aggravated by use of the eyes. There is heat, and burning pain, 
with pricking and itching and a constant sense of heaviness and 
of sand in the eyes (Noyes). 

Treatment. — Ascertain and remove the cause. Half tea- 
spoonful of common salt to a pint of water, and a teaspoonf ul of 
" Pond's extract" to a tumbler of water, are applications in pop- 
ular use (Noyes). Bathing the eyes with hot or cold water just 
before bed- time is useful. 

PRESCRIPTIONS FOR CONJUNCTIVITIS. 

R Sodii biboratis pulveris 3J. 

Aquae camphorae ^vj . — M. 

Sig. : Bathe the lids and drop into the eyes morning and even- 
ing. — Noyes. 

R Acidi borici 3j. 

Aquoe §vj. — M. Or 

R Zinci sulphatis gr. ij. 

Aquae §iv. — M. Or 

R Extracti opii fluid i ^ij. 

Aquae ^iv. — M. 

Sig.: Drop into the eyes morning and evening. — Noyes. 

R Argenti nitratis gr. ij.— v. 

Aquae destillatae gj. — M. 

Sig.: Two drops in the eye daily. (In granular conjunctivitis.) 

— Noyes. 

CONSTIPATION. 

Is a relative term, for some perfectly healthy persons have 
only one movement from the bowels every second or third day, 
while others have two stools daily. Cases are recorded where 
periods of three months have elapsed between two successive 
movements, and yet the individual was apparently in good health 
(Loomis). 



126 A COMPENDIUM OF PRACTICAL MEDICINE. 

•Causes. — In those accustomed to large doses of opium the 
bowels have been known to move only four times in a year. 
Abuse of laxatives, diseases of the brain and spinal cord, liver, 
heart, diabetes, general anaemia and chlorosis, anxiety and pro- 
longed mental labor are causes. A sedentary life, the feeble, 
infirm, the bed-ridden, child-bearing, and old age, are predispos- 
ing causes. Disregarding the calls to evacuate the bowels, the 
use of food leaving no resiclium, deficiency of the gastric and in- 
testinal juices, impaired muscular contractility and loss of peris- 
taltic movements are causes (Loomis). 

Symptoms. — The patient complains of sense of fullness in 
the rectum, with flatulence, headache, vertigo, a foul breath and 
anorexia. Eruptions such as psoriasis, eczema, prurigo, ery- 
thema and urticaria often appear upon the surface. There are 
flushings of the face, dark rings around the eyes, and sometimes 
palpitation. A distended colon may cause pain which is located 
either in the chest, bladder, groin, ovaries, testicles, loins or lower 
extremities (Loomis). 

Treatment. — For temporary constipation Epsom, or Rochelle 
salts are efficient. For habitual constipation, regular hours for 
the evacuation of the bowels, articles of food which leave a bulky 
residue, as cracked wheat, oatmeal and fruits which have fine 
seeds, as figs, strawberries and prunes sweetened with molasses 
are sometimes very efficient. A goblet of hot or cold water just 
before retiring and on rising will often be of service. Daily 
exercise in walking or horseback riding, friction and kneading of 
the abdomen and the galvanic, and faradic currents are efficient 
means. 

PRESCRIPTIONS FOR CONSTIPATION. 

B Extracti cascarse sagradse fluidi... 

Elixir simplicis aa |ij . — M. 

Sig. : Two teaspoonsful at bed time. — Bartholow. 

R Extracti nucis vomicse 

Pulverus piper, nig aa gr. xx. 

Pil. colocynth comp gr. 1. — M. 

In pil. no. xx. div. 
Sig. : One every night or second night. — Fothergill. 



convulsion's. 127 

R Pulveris aloes socot gr. vij. 

Pulveris rhei gr. xxiv. 

Extracti belladonna? gr. i. — M. 

In pil. no. xii. div. 
Sig. : One or two pills as required. — DaCosta. 

CONVULSIONS. 

Sjjasni is sometimes used synonymously with convulsion; but 
there is this difference : the word spasm is used when we wish to 
express the idea of less extensive muscular contraction; and con- 
vulsion, when the disorder affects the muscles of the whole body. 
Spasms may be clonic or tonic, and so may convulsions. Convul- 
sions may be accompanied by a loss of consciousness and sensi- 
bility, as in epilepsy or not so as in tetanus. When convulsions 
occur in children, as they often do from reflex irritation during 
teething, from disordered digestion or from poison in the blood, 
they are then called infantile convulsions. Children often have 
convulsions as the precursors of febrile diseases. Convulsions 
may be symptomatic of any cerebral disease (Loomis). 

Treatment. — The discovery of a cause will indicate the treat- 
ment. Belladonna and the bromides may be used. Hot baths, 
counter-irritants to the back and neck, or cold to the head, are 
often of service. Chloroform is the most appropriate agent for 
controlling the spasms temporarily (Loomis). 

PRESCRIPTIONS FOR CONVULSIONS. 

R Olei ricini 3j. 

Sig. : A teaspoonful or two according to age. (When due to in- 
digestion.) — Witherstine. 

R .Etheris fort giv. 

Sig.: To be used as an inhalation until paroxysm is broken. 

—J. L Smith. 
R Misturse asafcetidse jfij. 

Sig.: A tablespoonful as an anema. — Waring. 

R Potassii bromidi 3J. 

Aquae menthse piperita? fij. — M. 

Sig.: A teaspoonful every three hours for a day or two. 



128 A COMPENDIUM OF PRACTICAL MEDIC INE. 

CORYZA. (See Catarrh.) 
CROUP. (Spasmodic.) 

Called also spasmodic laryngitis or false croup in contradis- 
tinction to true croup, is a common disease. It occurs ordinarily 
between the ages of two and five years. 

Causes. — In some families there is an hereditary tendency. 
The exciting cause in most cases is exposure to cold. False 
croup is common in the commencement of measles. 

Symptoms. — Spasmodic croup is usually preceded for a day 
or two by a slight cough and mild nasal catarrh. It commences 
in most patients at night after the first sleep between ten and 
twelve o'clock. The child awakens with a loud, barking cough. 
There is great dyspnoea due to swelling and tension of the vocal 
cords. The face is flushed and expressive of suffering. The 
child cries. The skin is hot, the pulse accelerated, the voice 
hoarse. From a half to three hours these symptoms abate. 
Sometimes the attack is repeated once or more during subsequent 
nights. 

Differential Diagnosis. — Spasmodic croup may be mistaken for 
true croup. The friends usually make this mistake before the 
physician arrives. True croup begins gradually. The cough 
becomes more harsh and the respirations more difficult by degrees, 
by day as well as by night. On the other hand, false croup 
commences abruptly at night with severe symptoms from the 
first. The cough in false croup possesses a loud, sonorous char- 
acter, while in true croup it is harsh and less full. False croup 
must not be confounded with laryngismus stridulous or internal 
convulsions. The latter is not inflammatory, but purely spasmo- 
dic, suddenly commencing and abating (Smith). 

Treatment. — To relieve the spasmodic action of the laryngeal 
muscles, a warm bath should be employed at once, and the pa- 
tient kept in ten or fifteen minutes. In mild cases, a warm foot- 
bath may be sufficient. An emetic should be given at the same 
time with the bath. To children under three years, syrup of 
ipecac should be given in doses of one teaspoonful, repeated in 
twenty minutes, till vomiting occurs. Children over the age of 



croup. 129 

three years are best treated by the compound syrup of squills in 
teaspoonful closes till vomiting is produced. Rochelle salts 
should be given after the nausea from the emetic has subsided. 
Inhalation of the vapor of hot water and a sinapism over the 
neck and upper part of the sternum are useful aids. Spraying 
the throat with a solution of two drachms of sodium bicarbonate 
to a pint of lime-water is effective. Five or six drops of syrup 
of ipecac, or of compound syrup of squills should be given 
every third hour the next day. The atmosphere in the room of 
the patient should be loaded with moisture. Trosseau applied 
a sponge soaked in water as hot as can be borne, to the larynx, 
repeated in ten minutes. The hoarseness, dyspnoea, and cough 
diminish with this treatment. 

PRESCRIPTIONS FOR SPASMODIC, OR CATARRHAL CROUP. 

{& Potassii bromidi 

Chloral hydratis aa gr. xx. 

Syrnpi acacise gj. — M. 

Sig.: - A teaspoonful or less, according to age. — Ellis. 

J& Tincturse aconiti radicis gss. 

Sig.: One drop in a teaspoonful of water every hour till urgent 
symptoms abate; then every two or three hours. — Ringer. 

jfc Pulveris aJuminis ^ij. 

Syrupi ipecac §j. — M. 

Sig. : One teaspoonful every twenty minutes until vomiting is 
produced. A hot mustard foot-bath should be given at the same 
time. — J. L. Smith. 

|& Syrupi ipecacuanhas §ij. 

Sig. : A teaspoonful every fifteen minutes until vomiting is pro- 
duced. Then five or ten drops every three hours the next day. 

— Meigs and Pepper. 

CROUP. (Membranous). 

Called also true croup, or pseudo-membranous laryngitis, is 
a common and fatal disease, and occurs most frequently between 
the ages of two and twelve years. Some authorities regard 
membranous croup as only a laryngeal diphtheria. 

Causes. — According to J. L. Smith, the causes of croup are. 



130 A COMPENDIUM OF PRACTICAL MEDICINE. 

diphtheria, "taking cold," measles, pertussis, scarlatina, typhoid 
fever, and irritating inhalation. 

Symptoms. — Membranous croup commonly begins gradually 
and insidiously, revealed at first to the physician by hoarseness 
or huskiness of the voice, and a hoarse or harsh cough. Accord- 
ing to Bartholow, it is a purely local affection, and occupies the 
larynx exclusively. The exudation is on and not in the mucous 
membrane, and blood-poisoning never results. Occasionally 
masses of pseudo- membrane are expectorated. The dypsnoea 
gradually increases. Whitish or grayish patches of false mem- 
brane may be seen on the fauces. 

Prognosis. — It is one of the most fatal diseases of childhood 
v(Loomis). 

Treatment. — The agents which have been most employed for 
the purpose of dissolving the false membrane are lime-water, 
lactic acid, pepsin and trypsin. Smith uses the following 
formulae in the steam atomizer with good results : 

R Sodii bicarbonatis gij. 

Aqua? calcis 0. j. — M. 

Liquid trypsin may be employed with lime-water. 

B Extracti pancreatis (Fairchilds)....3J 

Sodii bicarbonatis 3iij . — M. 

Add one teaspoonful of this to six teaspoonsful of water, and 
apply every half hour with a camel's hair pencil. 

R Liquor potassse.- 3J. 

Aquae calcis O.j. — M. 

This may be inhaled from the steam-atomizer. 

Calomel has been used with good results in doses of from 
f[\Q to ten grains in the commencement of the disease. 

PRESCRIPTIONS FOR MEMBRANOUS CROUP. 

K Hydrargyri sulphatis flav......,,..,gr. ij-v. 

In pulv. no. 1, 
Sig.: Use as an emetic. — Fordyce Baker. 

li Acidi lactici Siiiss. 

Aquse destillatse gx.—M. 

Sig.: Apply with atomizer or brush frequently. (To dissolve 

the membranes.) — Mackenzie. 



CYSTITIS. 131 

CYSTITIS. 

Is an inflammation of the mucous membrane lining the 
urinary bladder. It is acute or chronic. 

Causes. — Foreign bodies, especially calculi, in the bladder? 
blows, protracted retention of urine, scarlet, typhus, and typhoid 
fevers, pyaemia, septicaemia, small -pox, diphtheria, myelitis > 
urethritis, pyelitis, and pelvic cellulitis may cause cystitis. Ureth- 
ral stricture, paralysis of the bladder, gout and some forms of 
kidney disease- are accompanied by chronic cystitis (Loomis). 

Symptoms, — Acute cystitis is always accompanied by fre- 
quent micturition, only a few drops being voided at each 
attempt. After its passage the patient strains to pass more. 
There are dull aching pains over the pubis; sometimes the pains 
in the vesical region are agonizing, and there is a constant burn- 
ing sensation along the urethra. The urine is cloudy, deposits 
mucus on standing, is alkaline, and sometimes fetid. Acute 
cystitis lasts about one week. Chronic cystitis is often only 
indicated by a frequent desire to pass urine. Usually there is a 
constant, dull, aching pain, or a sense of weakness over the 
bladder. Only a small quantity of urine is passed with each 
act (Loomis). 

Treatment. — In acute cystitis, the patient must have perfect 
rest. Warm hip-baths give relief. Rectal injections of opium 
and belladonna are always indicated, with large poultices and 
very r hot fomentations over the bladder. The bowels should be 
kept free. For the pain, chlorodyne is the best. Twenty minims 
of liquor potassae in mucilage may be given three times in 
twenty-four hours. In chronic cystitis, the catheter is to be reg- 
ularly and persistently used. The bladder should be washed out 
with weak solutions of borax. Very weak solutions of salicylic 
acid, carbolic acid, permanganate of potash, and chloride of 
sodium are also recommended. The daily use of mineral water, 
like Vichy, is beneficial. Drachm doses after each meal of the 
" Lafayette mixture" are very serviceable. 



132 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR CYSTITIS. 

B Bals. copab 

Spts. etheris nitros — aa gss. 

Liquor potassse 3j . 

Mucilag. acacise ad giv. — M. 

— "Lafayette Mixture."' 
All stimulating drinks are forbidden (Loomis). 

R Atropine sulphatis gr. j. 

Acidi acetici gtt. xx. 

Aicoholis 

Aquse — aa 5ss.— M. 

Sig. : Four drops in a wineglassful of water before each meaL 
(In acute cystitis.) — Good ell. 

R Extracti tritici fluidi 

Syrupi amygdalae — aa 3ij- — M. 

Sig.: A dessertspoonful in water five or six times daily. (In 
chronic cystitis.) —Thompson. 

B Potassii citratis Sss. 

Spiritus chloroformi Siiss. 

Tincturse digitalis ZHLxxx. 

Infusi buchu S viij . — M. 

Sig. : Two tablespoonsful three or four times daily. — FothergilL 

CANCRUM ORIS. 

Called also gangrene of the month, noma, aqneons cancer of 
infants, is a disease of childhood occurring between two and six 
years. The point of attack, which is most frequently the inside 
of the cheek, becomes inflamed, thickened and indurated, then a 
purple hue appears, followed by sloughing and gangrene (J. L. 
Smith). 

Causes. — This is a very rare disease. It occurs in debilitated 
and cachectic children, and in those recovering from acute dis- 
eases, such as scarlet fever (Loomis). 

Symptoms. — It commences with pain in the mouth, an ab- 
normal quantity of saliva, and offensive breath. Finally an 
ulcer appears, with a dark, ashy- brown colored slough. It may 
perforate the cheek. 

Prognosis. — Nineteen out of twenty die (Loomis). 



CARDIALGIA CATALEPSY. 133 

Treatment.— Nitrate of silver, and even strong nitric acid, 
should be applied to the slongh, and the month washed with 
solutions of carbolic acid and chlorate of potash. The best 
internal remedies are quinine, hydrochloric acid and stimulants 
(Loomis). 

CARDIALQIA. 

Signifies pain at the cardiac orifice of the stomach of a burn- 
ing character and shooting into the chest, and up the oesophagus 
into the throat. It is vulgarly called heartburn. Everyone has 
occasionally experienced this symptom. It characterizes certain 
cases of indigestion, and it is evidently dependent on the presence 
of an acid in the stomach, as it is quickly and completely re- 
lieved for a time by an alkaline remedy, such as lime-water, 
liquor potassse, bicarbonate of soda and magnesia. 

CATALEPSY. 

Is a functional disease of the nervous system, closely allied 
to hysteria and epilepsy. It is characterized by loss of conscious- 
ness, sensation and volition, accompanied by a peculiar muscular 
rigidity in which the limbs remain for some time in whatever 
position they are placed (Loomis). 

Causes. — Catalepsy may occur at any age, but it is more 
common in females about the age of puberty. It may precede 
melancholia and epilepsy. Traumatism, strong emotions, fright, 
shock, and religious excitement may induce an attack (Loomis). 

Symptoms. — Catalepsy occurs in parox} T sms. Consciousness 
is suddenly lost, and the limbs are as rigid as if petrified. The 
face has a death-like appearance. The skin is cold and temper- 
ature is sub-normal. The attack may last a few minutes, several 
hours, or for days. 

Prognosis. — As a rule, favorable (Loomis). 

Treatment. — An emetic will generally cut short an attack. 
The faradic current may be employed to arouse the patient. 
Morphine may stop the paroxysm, given hypodermically. Asa- 
fcetida, valerian, camphor and turpentine may be given. 



134 A COMPENDIUM OF PRACTICAL MEDICINE. 

CEPHALALGIA. (See Headache). 
CEREBROSPINAL MENINGITIS. 

Called also spotted, petechial and congestive fever, is an in- 
flammatory affection of the arachnoid and pia mater of both 
the brain and spinal cord. 

Causes. — Epidemics have occurred at all seasons, but more 
often in cold weather. It is most likely to attack those between 
ten and eighteen years of age. Cold, damp and overcrowded 
houses predispose to it. The real cause is not known (Loomis). 

Symptoms. — In some cases the patient is suddenly seized 
with a chill, loss of consciousness, becomes comatose, and dies in 
a few hours. Headache in most cases is prominent, and even in 
a condition of coma, causes the patient to groan. Pain in the 
back and upper part of the spine is a characteristic symptom of 
the disease. Attempts to flex the head on the chest increase 
the pain, and pressure against the back of the neck often induces 
excruciating agony. Soon the muscles at the back of the neck 
become stiff, and the head extended (opisthotonos). Attempts 
to swallow are painful. The temperature, as a rule, is low. The 
pulse is from 120 to 150. The pupils are often unequal in size. 
The face is pale and anxious, and has a dusky hue. Delirium 
comes on. The pains are shooting and lancinating in character. 
The eruption is usually limited to the face, neck and lips; it is 
herpetic in character. There is photophobia. 

Prognosis. — Unfavorable. From 30 to 80 per cent. die. 

Treatment. — The patient should be put to bed in a dark, cool, 
well -ventilated room, away from noise. The diet should be 
milk. Opium, bromide of potassium, quinine, and ergot in 
proper doses are useful. Cold applications to the head, mustard 
foot-baths, and mustard to back of neck are serviceable. 

PRESCRIPTIONS FOR CEREBROSPINAL MENINGITIS. 

R Morphias sulphatis gr. ss. 

Acidi sulphurici aromat 3j. 

Elixir einchonse ad ,^vj — M. 

Sig. : A teaspoonful every two hours for a child twelve years old. 

— Meigs and Pepper. 



CEREBRO- SPINAL MENINGITIS — CIRCUMCISION. 135 

R Acidi hydrocyanici dilati Wi. xx-xl. 

Sodii bicarbonatis gi iss. 

Sy rupi simplicis 

Aquse aa q. s., ad giiss. — M. 

Sig. : A teaspoonful every three or four hours for severe vomit- 
ing. — Delafield. 

R Hydrargyri chloridi mitis 

Pulveris j alapae 

Sacchari albi aa. 3j . — M. 

In pulv. no. x. div. 
Sig. : A powder every hour until free purgation occurs. 

— Robert. 

CHICKEN=POX. (See Varicella.) 

CHIN=COUGH. (See Whooping- cough.) 

CIRCUMCISION. 

Was instituted as a religious rite by Abraham, about 2,000 
years before Christ. 

Several Eastern nations still practice it as a hygienic 
measure. The chosen people preserve the custom as a religious 
ceremony, performing it on the eighth day. 

Operation. — Mark off with an aniline pencil the limits of the 
integument which it is proposed to remove. This line should 
follow the curve of the corona glandis at a short distance in front 
of it. Now seize the redundant prepuce with the forceps so that 
the aniline line shall lie just in front of the closed blades, taking 
care not to include the glans in the grasp of the forceps. With 
scissors cut off the outer portion. After the forceps has been 
removed, the inner layer of the prepuce is to be slit down to the 
corona upon the dorsum of the glans and the entire mucous 
membrane to be trimmed away on either side up to the frenum, 
leaving only enough tissue to serve to hold the sutures. Primary 
union seems always to occur. In the infant no suture is re- 
quired. The parts coapt naturally, and healing is accomplished 
usually in about forty-eight hours. In the adult, horse hair lias 
proved the best material with which to suture the cut edges. 
The first suture should be applied at the raphe. The ends of the 
suture are to be cut off about an inch long, to prevent the wound 



136 A COMPENDIUM OF PRACTICAL MEDICINE. 

from rolling in during the swelling of the first two days. It 
heals in from four to eight days. An opiate for sleep and a lax- 
ative are the only medicines usually required (Keyes). 

COMA. 

Is complete loss of consciousness, and there is the appear- 
ance of the profoundest sleep. The face wears a confused look; 
the pupils are sluggish, often dilated ; the mouth is open, the 
tongue dry. Sensation may be blunted, but is not destroyed ; 
nor is motion, for the patient moves when his skin is pinched or 
tickled. Coma always betokens a serious disturbance of the 
functions of the brain (DaCosta). 

Causes. — The cranial causes are : Hyperemia, anaemia, 
oedema, compression, tumors, thrombosis, embolism, apoplexy, 
abscess, softenings, shock, and concussion. The most thorough 
coma is seen in apoplexy; it comes on quickly, and is attended 
with a noisy respiration and a slow pulse. The extra cranial 
causes are : Hysteria, epilepsy, uraemia, cholaemia, poisons of 
drugs, narcotics and anaesthetics, anti-spasmodics, alcohol, poisons 
of fevers, malaria, etc. (Loomis). 

Treatment. — Discover and treat the cause. 

CORNS. 

Are small callous thickenings of the skin, especially on the 
toes, the result of occasional pressure. Dr. Sayre writes that a 
corn is infinitely more painful than a cancer, and is capable of 
inflicting torment and agony sufficient to destroy the sweetest 
disposition, and upset the best regulated families. There are 
two varieties of corns, the hard and the soft. The soft corn is 
found between the toes, is exceedingly tender, and is liable to 
become inflamed. The hard corn has a hard, white core in the 
centre. The irritation produced by pressure upon these forma- 
tions may give rise to reflex muscular contractions which will 
draw the toes up. 

Treatment. — Shoes must be worn which will permit expan- 
sion of the foot. Pare the corn as much as possible without 
drawing blood. Then rub the surface with solid stick of nitrate 



COLD EEET COUGH. 137 

of silver, and in a few clays another layer will come off. Now 
surround the corn with narrow strips of adhesive plaster to pro- 
tect it from pressure. To the soft corn apply concentrated nitric 
acid or the solid stick of nitrate of silver, and place a pledget of 
cotton between the toes. In a few days the hardened mass will 
come away. Glacial acetic acid, and carbolic acid, are good 
applications. According to Bartholow, no application is so cer- 
tain, prompt and effective, for the cure of corns, as liquor potas- 
sae. It should be applied by means of a glass rod to the summit 
of the corn and the tissue softened by it scraped off. By suc- 
cessive applications the callosity is removed without pain or dis- 
comfort. 

COLD FEET. 

Many persons, especially women, are troubled with cold 
feet, particularly at night; so cold, indeed, as to effectually pre- 
vent sleep for hours. This condition, which may rank as a dis- 
tinct ailment, is best treated by immersing the feet nightly for a 
few minutes in cold water, rubbing them whilst in the foot-bath 
diligently until they become warm and glowing, and then, after 
thorough drying, clothing them in thick, over -large woolen or 
"fleecy hosiery " socks. The feet may be sponged first with 
water as hot as can be borne, and then for a few seconds with a 
sponge wrung out of cold water (Ringer). Dr. Chapman asserts 
that the ice-bag, applied along the lower dorsal and lumbar ver- 
tebrae, by increasing the flow of blood to the legs, proves very 
comfortable to persons harassed with cold feet; and he has often 
seen the feet become comfortably warm a few minutes after the 
application of ice. According to Dr. Anstie, strychnia promotes 
capillary circulation, and he recommends it in troublesome cold- 
ness of the feet and hands. 

COUGH. 

Is a sudden and violent expiration, having usually for its 
object the expulsion of some annoying substance from the air 
passages. But it may be purely nervous. A nervous cough 
sometimes occurs in children and in chlorotic girls. The cough 
is usually in paroxysms, has a peculiar barking tone and resem- 



138 A COMPENDIUM OF PRACTICAL MEDICINE. 

bles whooping cough. It is short, painless, and without expec- 
toration. 

Causes. — In children, it may result from diseases of the 
brain, from dentition, from worms, and spinal irritation. In 
others, anaemia, hysteria and nervous excitement may be the 
cause. It may be induced by involuntary imitation. A school 
for girls was suspended on account of the large number of cases 
(Flint and Smith). 

Treatment. — Tonic remedies, a nutritious diet, out- door life, 
quinia and small doses of strychnia are useful. No remedy is so 
useful in ordinary cases as iron. Dr. Cameron used the follow- 
ing prescrirjtion : 

R Ferri subsulphatis £ss. 

Acidi nitrici 3ss. 

Aquae destillatse , , , , , ^ss. — M. 

Sig. : Three drops four times daily in sweetened water. 

R Tincturse belladonnas gtt. xxxij. 

Potassii bromidi 

Ammonii bromidi — aa 3J . 

Syrupi simplicis ^ij. — M. 

Sig.: One teaspoonful three times daily. (For a child three 
years.) — J. L. Smith. 

There are several kinds of cough ; according to the amount 
of expectoration, a cough is dry or moist ; according to its ori- 
gin, it is laryngeal, tracheal, bronchial, sympathetic, etc. 

A dry cough is indicative of irritation either in the larynx, 
trachea, bronchi, or in the lung substance. An elongated uvula, 
pleurisy, and the earlier stages of phthisis may give rise to a dry 
cough. But the irritation may not be situated at all in the 
respiratory system. Affections of the liver, stomach, intestine, 
uterus or brain will occasion an obstinate dry cough. Cough is 
frequently preceded by a sensation of tickling in the larynx. 
Lying down often increases its intensity. 

PRESCRIPTIONS FOR COUGH. 

R Misturae asafoetida 3iv. 

Ammonii muriatis gj. — M. 

Sig. : A tablespoonful as necessary. (For sympathetic and cough 
maintained by habit.) — Bartholow. 



COUGH. 139 

R Chloral hydratis 

Camphorse — aa §ss. — M. 

Triturate in a mortar till a clear fluid is formed. 
Sig.: Paint with a camel's hair brush over the larynx to allay 
spasmodic cough. — Bartholow. 

R Extracti gelsemii fluidi giij. 

Sig. : Three to five drops in water every two hours until droop- 
ing of the eyelids and dilation of the pupil takes place. (For nervous, 
spasmodic, reflex and irritative cough.) — Bartholow. 

R Acidi hydrocyanici diluti 3j. 

Tincturse sanguinarise giv. 

Syrupi senega? ^ss. 

Syrupi tolutan £ij . 

Aquae lauro-cerasi 5vij — M. 

Sig. : One or two teaspoonsful, according to age, every three or 
four hours. (For irritable, nervous, and cough by habit.) 

— Bartholow. 

Syrup of wild cherry and syrup of lactucarium are excellent 
vehicles for cough mixtures. 

R Aluminis 3j. 

Aquas §vj. — M. 

Sig.: Use in the form of a spray for chronic coughs and hoarse- 
ness. — Ringer. 



■o v 



R Chloroformi gj . 

Morphia sulph gr. iss. 

Glycerinse §ij . — M. 

Sig. : A teaspoonful when cough is troublesome. 

t> Olei morrhuse O.j. 

Sig. : A teaspoonful three times daily, for a while, then increase 
to tablespoonful. (For chronic cough.) 

A drop of pure beech -wood creosote may be given with the 
cod-liver oil. 

A teaspoonful of glycerine added to water or a little lemon - 
juice, is often useful in coughs, even the cough of phthisis. 

This dose, taken at night, often lessens morning cough 
(Ringer). 

Glycerine of tannin is a very useful application to the throat 
when chronically inflamed and so productive of cough, which is 
often the case in children. 



140 A COMPENDIUM OF PRACTICAL MEDICINE. 

The tincture of iodine may be used as an inhalation in the 
chronic forms of phthisis to allay the troublesome cough; and as 
an inhalation for children with hoarse, hollow cough, accompanied 
by hoarseness and wheezing at the chest. Use as follows : Pour 
twenty to thirty drops of the tincture of iodine in a half or a 
pint of boiling water; then direct the patient to put his face 
over the mouth of the vessel and breathe the iodized steam for 
five or ten minutes night and morning with the head covered 
with a towel to prevent escape of the steam (Ringer). 

According to Rummo a four per cent, solution of iodoform 
in spirits of turpentine, used as an inhalation or spray, will 
diminish the cough of phthisis and chronic bronchial catarrh. 

According to Ringer, in the obstinate winter cough with 
difficult breathing and wheezing, the wine of ipecac applied as a 
spray to the fauces once or twice daily is very efficacious. The 
wine may be used pure or diluted. 

COMEDONES.— (See Acne.) 
CYSTS. 

Are developed in many ways : some are possibly new 
growths, some are formed in an accidental way by simple effu- 
sion of fluid into connective tissue, and others are produced by a 
dilatation of occluded ducts, or natural gland orifices, the cysts 
enlarging by the secretion of the ducts or gland contents. Of 
these the mucous cysts of the mouth and vagina, the sebaceous 
cysts of the skin, and the milk cysts of the breasts are the best 
examples (Bryant). 

Varieties. — Serous cysts, mucous cysts, sebaceous cysts, oil 
cysts and dermoid cysts. 

Serous Cysts are most commonly found connected with the 
kidney, ovary, thyroid or breast. They are sometimes seen in 
the neck. They contain a limpid, watery fluid, and, are painless. 

Treatment. — It is dangerous to tap or extirpate a cervical 
cyst. Let it alone. 

Mucous Cysts are found wherever mucous glands exist, and 
are caused by some obstruction to the escape of the gland con- 
tents. They are found on the lips, within the cheeks, on the 



CALCIFICATION CHLOASMA. 141 

tongue and gums, and beneath the tongue when they are called 
ranida. They contain a thick ropy fluid. 

Treatment. — They may be excised, or their walls cut into. 

Sebaceous Cysts appear as congenital and acquired tumors. 
Some are caused by obstruction to the orifice of the sebaceous 
glands. The congenital sebaceous cyst is deeply placed, and is 
more common about the orbit and brow. They contain a whitish 
or yellowish liquid secretion and sometimes hair. The acquired 
sebaceous cyst may be found on any part of the body, but it is 
more common on the head and face. When on the scalp, they 
are known as wens. 

Treatment. — The only correct treatment is their removal. 

Dermoid Cysts are frequently met with situated deeply be- 
neath the skin and muscle. They are congenital, filled with 
sebaceous matter, and often contain hair. 

Treatment. — They should be dissected out. 

Oil Cysts are met with but rarely, and are probably always 
dermoid. 

CALCIFICATION. 

Called, also, calcareous degeneration, or cretefaction, is an 
infiltration of the tissues with the phosphate and carbonate of 
lime. Calcified tissues are recognized by their hard, sometimes 
stony consistence. Tissues which have undergone fatty degen- 
eration are especially prone to calcification. In the vast majority 
of cases of calcification, the lime is deposited in tissue previously 
diseased. Of great practical importance is the calcification of 
the cardiac valves in chronic endocarditis, and of the internal 
and middle coats of the arteries in old age (Flint). Removing 
tumors from the pelvic or abdominal cavity, when the tissues 
and arteries are calcified, gives rise to troublesome or even fatal 
hemorrhage. 

CHLOASMA. 

Is a diffuse form of excessive pigmentation. It is most fre- 
quently met with in women during pregnancy, and also in un- 
married females between the ages of thirty and the cessation of 
the menses, as a result of disordered menstruation, and of (lis- 



142 A COMPENDIUM OF PRACTICAL MEDICINE. 

eases of the sexual organs. It has the appearance of a dirty 
yellow or brown discoloration, generally implicating the face, 
and often extending across the forehead from temple to temple, 
and from near the eye -brows to near the roots of the hair. 

Treatment. — Careful attention must be paid to the general 
health and sexual organs. The local treatment is most import- 
ant. Some local applications, such as mustard, cantharides, and 
croton oil, are apt to be succeeded by new epidermis which is 
more deeply pigmented than that which it has replaced, and are, 
therefore, to be avoided; while others, such as perchloride of 
mercury solutions, have exactly the opposite tendency. We 
may use a perchloride of mercury solution of the strength of 
iive grains in an ounce of alcohol in the following manner: Place 
the patient in bed and apply compresses dipped in the above 
solution. Moisten the compresses from time to time with the 
fluid without displacing them. The compresses are removed in 
four hours, when the skin is found to be reddened or blistered. 
If blistered, let out the fluid and dust the surface with starch 
powder. 

CRAMP. 

In writers' cramp, the flexor muscles of the thumb and 
fingers become rigidly contracted. Pianists, violinists, printers, 
tailors, etc., are sometimes similarly affected. In the treatment 
of writers' cramp and allied affections, discontinuance of acts 
which occasion the spasm is essential. Galvanism is most useful. 
It seems to be a central, not a peripheral affection. Some persons 
are liable to suffer much from cramp of the muscles of the leg 
or feet, occurring especially at night. Bardsley's treatment con- 
sists in sleeping on an inclined plane, the bed being twelve 
inches higher at the head than at the foot. Galvanism is very 
effective in these cases (Flint). 

Cramp may occur in any muscle. Occasionally the stomach 
is the seat of cramps, and causes great pain, and ejection of food. 
Galvanism seems to be more effective than other forms of treat- 
ment. 



CIREHOSIS DEBILITY. 143 

CIRRHOSIS. (Of Liver.) 

Called also interstitial hepatitis, is an inflammation of the 
connective tissue of the liver. It has been named sclerosis of 
the liver, "Gin -drinkers 77 liver, "hob-nailed 77 liver, etc. 

Causes. — The chief cause of cirrhosis is the intemperate use 
of alcohol. When it is taken in a concentrated form without 
food, it acts as a direct irritant to the hepatic circulation. If 
this irritation is long continued cirrhosis is the result. Those who 
take alcohol before breakfast as well as through the day are 
almost certain to develop cirrhosis of the liver. Those who 
partake freely and daily of highly seasoned food, even though 
they may not use alcohol, are also liable to develojD cirrhosis. 
SyiDhilis, gout and rheumatism cause it (Loomis). 

Symptoms. — Dull pain and tenderness in the hepatic region, 
dyspnoea, apathy, headache, nausea and furred tongue, and loss 
of appetite, especially for meats, are the chief symptoms. There 
may be slight jaundice. Tympanites as well as intestinal catarrh 
usually precedes ascites. Before the ascites, the abdominal veins, 
especially of the right side, are sometimes enormously distended. 
Ascites is sometimes absent. The stools in cirrhosis are charac- 
teristic. They are clay- colored in the centre; surrounding this 
there is a dull pinkish ring, and around this a slate grey ring 
tinged with mucus. The urine is scanty and very dark colored 
(Loomis). 

Prognosis. — Unfavorable. 

Treatment. — All spirituous liquors must be abstained from. 
Nitro- muriatic acid and cod-liver oil are useful. Dilute nitric 
acid and columbo assist stomach digestion. Creosote and sul- 
phite of sodium are of service, when acid fermentation is a dis- 
tressing symptom. For the ascites and general dropsy, squills 
and digitalis are effective; but when they fail, tapping must be 
resorted to (Loomis). 

DEBILITY. 

Dr. Anstie highly extolled alcoholic stimulants in the debil- 
ity of old age, especially in the condition of sleeplessness, at- 
tended often with slow and ineffectual digestion and a tendency 



144 A COMPENDIUM OF PRACTICAL MEDICINE. 

to stoinach cramps. He employs a generous and potent wine 
containing much ether. According to Ringer, the good old- 
fashioned remedy, ram or brandy and milk taken before break- 
fast, is useful in phthisis and in exhausting diseases, and is a 
good prop to town -living women who suffer from morning ex- 
haustion. Arsenic is useful for the swollen feet of old or weakly 
persons; or for old people with a weakly acting heart and feeble 
circulation, who often suffer from breathlessness on exertion. 
Cod-liver oil is useful in chronic degenerative diseases of old 
age. In nervous and general debility, cod-liver oil and the hypo- 
phosphites are highly useful. Quinia is of great benefit to pale 
and badly fed town dwellers. Sea bathing is recommended in 
chronic illness with debility. 

PRESCRIPTIONS FOR GENERAL AND SENILE DEBILITY. 

R Tincturae ferri chloridi 

Syrupi simplicis — aa §j. 

Aquae cirmamomi ^ij . — M. 

Sig. : A teaspoonful three times daily. — Charity Hospital. 

R Spiritus chloroformi ^v. 

Acidi hydrochlorici dil ^ijss. 

Infusi cinchonae .' ^xv. — M. 

Sig.: Two tablespoonsful three times daily. — Fothergill. 

R Quiniae sulphatis gr. xxx. 

Acidi sulphurici diluti q. s., ad. ft. sol. 

Aquae §ij. 

Tincturae ferri chloridi gss. 

Spiritus chloroformi 3vj . 

Glycerinae ^iv. — M. 

Sig. : A teaspoonful three times daily. — Loomis. 

DELIRIUM. 

This is a wandering of the mind, the patient muttering 
incoherent words. It is more common in the young and nervous 
than in the old. The delirium may be quiet or active. It may 
be brought on by acute diseases, especially fevers. 



DELIRIUM. 145 

DELIRIUM. (Tremens.) 

Occurs most frequently in old topers after a severe drinking 
bout, or it follows the sudden withdrawal of stimulants, or an 
attack may be induced by some strong moral emotion or excite- 
ment, or by an accident or injury (Loomis). 

Symptoms. — The appetite is lost and even the drink is 
rejected. The trembling increases ; the manner grows excited 
and irritable. Insomnia is an early symptom. Hallucinations 
and illusions come on. ■ The delirium usually begins at the 
moment of falling asleep or in awaking. He then sees frightful 
objects — goblins, demons and monsters — but fully awake they 
vanish. This preliminary state is often called "the horrors. 11 
As the case progresses the hallucinations become constant. The 
patient sees snakes on the wall and bed, and endeavors to escape 
from them. He may be noisy, furious, and dangerous. There 
may be illusions of smell and hearing. Delirium tremens usu- 
ally lasts about two weeks, by which time recovery or death 
will have taken place (Bartholow). 

Treatment. — Provide suitable aliment for the patient and try 
to procure sound sleep. Milk and lime-water may be given 
freely, to which it may be advisable to add whiskey or brandy. 
Egg-nog, beef-juice and other animal broths should be well for- 
tified with red- pepper. For securing sleep, one -fourth of a grain 
of morphine and fifteen grains of chloral may be given, if the 
heart is not weak. Bromide of potassium in full doses may be 
given for u the horrors. " Pilocarpine, tincture of digitalis in 
drachm doses, tincture of cannabis indica, and chloroform inter- 
nally may be used with advantage. 

PRESCRIPTIONS FOR DELIRIUM. 

jfc Potassii bromidi 

Sodii bromidi aa gr. xv. 

Chloral bydratis gr. x. 

Tincturse zingiberis IHx. 

Tinctune capsici IMv. 

Spiritus ammonii aromat 3J. 

Aquae q. s., ad gij. — M. 

Sig. : Dose, sij. — Starr. 



146 A COMPENDIUM OF PRACTICAL MEDICINE. 

J& Chloral hydratis £ss. 

Syrupi aurantii corticis 

Aquae aa gss. — M. 

Sig. : To be taken in one dose, and repeated if necessary. 

— Liebreich. 

|& Potassii bromidi gss. 

Sy ru pi simplicis §j . 

Aquae foeniculi q. s., ad giij. — M. 

Sig. : Two teaspoonfuls every two hours — Ringer. 

ffc Potassii bromidi 3j. 

In pulv. no. vii. div. 
Sig.: A powder dissolved in one-half tumblerful of water every 
four to six hours (In "the horrors.") — Bartholow. 

DIABETES INSIPIDUS. 

Called, also, polyuria, hyperuresis, and polydipsia, is char- 
acterized by extreme thirst, and the secretion of a large quantity 
of colorless urine, of low specific gravity, free from sugar and 
albumen (Loomis). 

Causes. — Diabetes insipidus may occur at any age and in 
either sex. Disturbance of the sympathetic ganglia causes dila- 
tation of the capillary vessels of the kidney, and produces dia- 
betes. Blows on the head, injuries to the medulla and spinal 
cord, and violent emotions have all apparently caused its 
development. Drinking large quantities of ice -water when over- 
heated, and exposure to cold and wet, are among its supposed 
causes (Loomis). Bartholow gives syphiloma of the brain as 
the most usual cause. 

Symptoms. — Its chief symptom is the passage of a large 
quantity of limpid urine; the quantity varies from thirty to 
sixty pints per day. Its specific gravity ranges from 1003 to 
1008; it is remarkably clear, and faintly acid. It contains no 
sugar or other abnormal ingredients. There is intense thirst. 
The skin becomes harsh and dry; and the temperature sub- 
normal. There may be salivation (Loomis). 

Prognosis. — Recovery from diabetes insipidus is rare. It 
may last many years. 

Treatment. — At all times the body should be warmly clothed, 
and the skin kept active. According to Bartholow, the iodides 



DIABETES. 147 

and mercury have quickly cured cases of syphilitic origin. 
Jaborandi and ergotin have been successful. A course of iodide 
of potassium should be at first administered, and if the disease 
does not yield, galvanism should be tried. 

PRESCRIPTIONS FOR DIABETES INSIPIDUS. 

jfc Extracti ergotae fluidi 31J. 

Sig.: A teaspoonful three times daily, increased to two tea- 
spoonfuls. — DaCosta. 

Jt Auri chloridi gj. 

Confect. rosse gr. xx. — M. 

Ft. massa et in pilulas no. xx. div. 
Sig.: A pill after meals thrice daily. — Bartholow. 

Jfc Pulv. Valerianae rad 3ii-iv. 

In chart, no. xii. div. 
Sig.: A powder three times daily. — Demange. 

DIABETES MELLITUS. 

Called also glycosuria, is a chronic disease characterized by 
the constant presence of grape-sugar in the urine, by an increased 
urinary discharge, and by progressive wasting of the body. It 
has at various times been regarded as a disease of the kidney, 
alimentary canal, liver, and nervous system, but its exact path- 
ogeny has never been determined (Loomis). 

Causes. — Diabetes occurs at all ages, but is most frequent in 
middle life. It appears to be hereditary in some cases. Shock 
or concussion of the whole body, or of the brain and spinal cord, 
blows upon the hepatic and renal regions, mental shocks, anxiety 
and chagrin may cause it (Bartholow). Pregnancy, impaired 
digestion, and immoderate use of sugar, new wine, and alcohol 
have also been named as causes (Loomis). Excessive activity in 
the glycogenic function of the liver may so overload the blood 
with sugar as to cause it to appear in the urine (Loomis). 

Symptoms. — Diabetes may be acute and result fatally within 
two or three weeks from the time the increased now of urine is 
noticed. But it usually comes on insidiously; the patient notices 
for some time that he has been passing more urine than usual. 



148 A COMPENDIUM OF PRACTICAL MEDICINE. 

and has been unusually thirsty. While his appetite is good, yet 
he is losing ilesh and strength; and there is an abnormal dryness 
of the mouth, throat and skin, with intolerable itching, followed 
by desquamation. There is loss of sexual desire. The tongue 
is red or coated ; the gums are pale, retracted and bleed easily > 
and the teeth become carious. There are nausea and vomiting, 
with constipation. The temperature, pulse-rate and respirations 
are below the normal. In some cases, there will be little thirst 
or loss of appetite and no emaciation (Loomis). 

The Urine. — Very rarely the amount of urine passed is but- 
little increased; generally it rises to twenty or fifty pints in 
twenty-four hours. The urine is acid, of a light straw color, 
without sediment. The specific gravity varies from 1030 to 1070 
with an average of 1040. In rare cases a low specific gravity of 
1008 or 1010 is recorded (Loomis). 

Prognosis. — The disease may last from a few weeks to ten or 
twelve years. Boils and carbuncles may complicate it (Loomis), 

Treatment. — Dieting is of the first importance. All sacch- 
arine form of food, or any article that can be converted into 
sugar should be avoided. Hence, starchy foods, bread, arrow- 
root, tapioca, sago, such vegetables as potatoes, parsnips, turnips, 
carrots, beans and peas, are to be absolutely avoided. Salads, 
greens, acids, fruits, all kinds of flesh and fowl, eggs, cheese and 
butter, unsweetened tea and coffee, can be taken. Baths and 
moderate exercise should be taken. Extract of opium, morphia, 
and codeia in small doses are useful. Mineral waters are given. 
If there is anaemia, iron, cod-liver oil, strychnia, and quinine 
should be given. Surgical operations should on no account be 
undertaken on diabetic patients. 

PRESCRIPTIONS FOR DIABETES MELLITUS. 

R Sodii salicylatis .^iv-vj. 

Glycerinse %j . 

Aquse ad Siij. — M. 

Sig.. Two teaspoonfuls three times daily. — DaCosta.. 

li Tincturse opii 3j 

Tiucturae ferri muriatis 3ix. — M. 

Sig.: Twenty drops three times daily. — Welleiv 



DIARRHOEA. 149 

R Sodii salicylatis 3iij. 

Liquor potassii arsenitis 3j. 

Glycerinse Sj. 

Aquae cinnamomi ad Siij- — M. 

Sig. : A dessertspoonful three times daily. — J. C. Wilson. 

DIARRHCEA. 

Is the frequent discharge of fluid or semi-fluid faeces. It may 
Ibe acute or chronic. 

Varieties, — I. Irritative Diarrhoea is that form induced by 
improper and unseasonable food, foul water, tainted meats, and 
drugs. 

II. Symptomatic Diarrhoea is a part of the natural history 
of typhoid fever, intestinal ulcerations, all forms of cholera, and 
other diseases. 

Ill Mechanical Diarrhoea is that form in which the faeces 
are made fluid by a large amount of serum poured into the 
intestinal canal, by the action of Epsom and Rochelle salts. 

IV. Nervous Diarrhoea may be caused by fright, grief, 
great anxiety, and severe pain. 

V. Vicarious Diarrhoea, occurs when the functions of the 
skin, kidneys or lungs are suppressed; the flux from the bowels 
affords relief. Chilling the body suddenly, or intense heat, brings 
on a vicarious flux. 

VI. Fatty Diarrhoea is the result of faulty pancreatic di- 
gestion. 

VII. Colliquative Diarrhoea is a copious flux occurring in 
wasting diseases toward their close, e. g., phthisis, cancer and 
Bright's disease. 

VIII. Chronic Diarrhoea is always associated with some 
form of chronic organic disease as chronic enteritis, intestinal 
ulcers, syphilis, malaria, scurvy and phthisis (Loomis). 

Prognosis. — Depends on the cause. In fatty diarrhoea 50 
per cent die. 

Treatment. — Depends on the causes which produce it. If it 
depends on undigested food, a full dose of castor oil, or rhubarb 
and soda should be given. The diet should be restricted to milk 
and lime-water. Camphor, kino, bismuth, or dilute sulphuric 



150 A COMPENDIUM OF PRACTICAL MEDICINE. 

acid raay be given. If there is griping, opium may be combined 
with the bismnth and camphor. 

In the treatment of chronic diarrhoea, bismuth is the most 
reliable drug (Loomis). 

PRESCRIPTIONS FOR DIARRIKEA. 

Jfc Spiritus lavandulae comp Sij. 

Tincturae opii .^ij . 

Tincturae rhei 3ss. 

Olei sassafras gtt. x. — M. 

Sig. : A teaspoonful after each meal. — Loomis. 

J£ Olei ricini ^ij . 

Pulveris acaciae — 

Pulveris sacchari aa gij. 

Tincturae opii Itt.xxi. 

Aquae cinnamomi ad ^iv. — M. 

Sig.: A teaspoonful every three or four hours. (For children.) 

—West. 

(fc Magnesii sulphatis 

Tincturae rhei 

Sy rupi zingiberis aa 3j • 

Aquae carui 5ix. — M. 

Sig.: A teaspoonful three times daily, to a child one year old. 

—West. 

Jfc Tincturse opii deodoratae gtt. xvi. 

Bismuthi subnitratis 3ij • 

Syrupi simplicis Sss. 

Misturse cretae Siss. — M. 

Sig.: Shake well and give teaspoonful every three hours to a 
child one year old. — J. L. Smith. 

Jfc Pulveris ipecac gr. ss. 

Pulveris rhei gr. ij . 

Sodii bicarbonatis... gr. xij. — M. 

In pulv. no. xii. div. 
Sig.: One powder every four hours to an infant one year old. 
(In indigestion with acidity.) — J. L. Smith. 

Jfcr Cretse praep 3ij. 

Tinct urae catechu 3 ss. 

Tincturae opii ITT .lxx x. 

Aquae cinnamomi ad 5 viij . — M. 

Sig. : Two tablespoonfuls after each motion. — Fothergill. 



DIPHTHERIA. 151 

DIPHTHERIA, 

Is one of the most dreaded, one of the most fatal, and, un- 
fortunately, one of the most common maladies of childhood. It 
is an acute, specific, contagious disease, beginning by an infec- 
tion of the throat, and characterized by a local exudation, 
glandular enlargements, and systemic poisoning, and having for its 
sequelae various paralyses (Barthelow). 

Causes. — Diphtheria is a contagious disease, propagated by 
a specific poison, the form of which is not known. It may pre- 
vail as an epidemic, or occur sporadically. Filth, bad sewerage 
and drainage, overcrowding, and a general bad hygienic condi- 
tion favor the development and spread of diphtheria. It is first 
a local, then a constitutional disease. The stage of incubation 
usually varies from one to eight days. No age is exempt, but 
from the second to the fifth year is the period of greatest suscep- 
tibility. Previous attacks afford no immunity against subsequent 
ones (Loomis). 

Symptoms. — Are both local and constitutional. The local 
symptoms begin with a sensation of dryness, prickling and pain 
in the throat. There is hyperemia of the fauces, and on the 
palate or tonsils, minute grayish -white patches appear. The 
false membrane is sometimes dark-red or even black. There 
may be swelling of the glands of the neck. The Eustachian 
tubes, (esophagus, posterior nares, larynx, vagina, and rectum 
may be involved. The constitutional symptoms are chill, fever, 
pain in the head and back, nausea, vomiting, and even convul- 
sions. The temperature may be 103° or 104° F., the pulse 120 
to 130. The patients condition grows worse each day. until 
about the end of one week, when the membrane is thrown off. 
The loss of tendon reflex often occurs as early as the first, sec- 
ond or third day. It is a symptom of diagnostic value. Dr. 
McDonnell made the following statement: "Knee-jerk is absent 
from the very first day of the illness, in many cases of diph- 
theria." 

Symptoms which indicate danger: 1. Diarrhoea may cause 
exhaustion. 2. Nausea and vomiting coming on late in the dis- 
ease. 3. Albuminuria, and coma may occur as a result of the 



152 A COMPENDIUM OF PRACTICAL MEDICINE. 

nephritis. 4. An irregular and intermittent pnlse throughout 
the entire course of the disease. 5. If the temperature falls to 
the normal, or below, and the exudation shows no sign of ex- 
foliating. 6. Convulsions occurring late in the disease. 

Sequelae. — After the exudation disappears and convalescence 
is apparently established, sequelae may- develop, which may con- 
tinue for months, and even years. The commonest is paralysis 
of some of the voluntary muscles ; the muscles most frequently 
affected are those of the soft palate and pharynx. There is diffi- 
culty in swallowing and inability to articulate clearly. As the 
pharyngeal paralysis is disappearing — or from two to ten days 
after — the muscles of the lower or upper extremity may be in- 
volved. Before the occurrence of the paralysis there will be a 
sensation of coldness, pricking, crawling and numbness in the 
part about to be affected. There may be paralysis of any muscle. 
Paralysis of the heart may occur. Diphtheritic paralysis is 
always entirely recovered from. These paralyses may follow the 
mildest as well as the more severe cases. In mild cases its dura- 
tion is two or three weeks, while in others it has continued one 
or two years. Other sequels are nephritis and endocarditis 
(Loomis). 

Differential Diagnosis. — The diagnosis of diphtheria rests on 
the presence of a membranous exudation. Ordinary sore throat 
or catarrhal pharyngitis is sometimes confounded with diphtheria. 
Membranous croup is a local affection, while diphtheria is a con- 
stitutional disease. Croup is not contagious or inoculable, while 
diphtheria is markedly so. In croup the exudation is on the 
surface of the mucous membrane; in diphtheria it is in its sub- 
stance as well as on its surface. The submaxillary glands may 
be, and often are, enlarged in diphtheria, but never in croup. 
An erythematous eruption sometimes makes its appearance on 
the upper part of the chest and back in diphtheria (Loomis). 

Prognosis. — Death rate is from twenty to fifty per cent. 
Duration varies from three to fourteen days. Cases that are 
apparently doing well sometimes terminate very unexpectedly 
and suddenly by paralysis of the heart. Complications make 
the prognosis more unfavorable. Death may occur from diph- 
theritic blood-poisoning. 



DIPHTHERIA. 153 

Treatment. — The patient should be kept in bed, and the 
room well ventilated, and have a temperature of 70 to 75 degrees. 
The patient should be kept scrupulously clean. Hot poultices 
should be applied externally to the throat ; steam inhalation 
should be constant fiom the onset of the disease, until the exuda- 
tion has disappeared ; iron and brandy should be given freely; 
and the diet should be fluid, milk preferably (Loomis). Accord- 
ing to Bartholow, a solution of lactic acid — strong enough to 
taste sour — frequently applied by means of a mop, gives excel- 
lent results. He also recommends highly the inhalation of the 
vapor, as it arises from the slacking of lime. The false mem- 
brane may be dissolved by very frequent inhalations of atomized 
lime-water and lactic acid. Bartholow gives the following to 
prevent systemic infection: 

j& Liquor iodi comp gij. 

Acidi carbolici 3j . — M. 

Sig. : One-fourth of a drop to two drops in water every four 
hours. Also, moderate doses of whiskey or brandy for the same pur- 
pose. 

He also recommends iron, quinine, strychnine, galvanism 
and faradism for the paralytic affections of diphtheria. As a 
solvent for the false membrane, Dr. J. L. Smith recommends the 
following : 

Jfcr Olei eucalypti 3ij. 

Sodii benzoat 3j • 

Sodii bicarbonatis 3ij . 

Glycerinse Sij . 

Aquae calcis 0. j. — M. 

Sig.: To be used with the hand atomizer from three to five 
minutes every half hour, or with the steam atomizer almost con- 
stantly. 

PRESCRIPTIONS FOR DIPHTHERIA. 

jfc Papayotin 5j. 

Aquae. 5iv. 

Glycerinae 3 viij . — M. 

Sig.: Apply locally to membrane. — Jacobi. 

|fc Trypsin gr. xxx. 

Sodii bicarbonatis gr. x. 

Aquae destillatae 5j. — M. 

Sig.: Apply locally to membrane. — Ferriald. 



154 A COMPENDIUM OF PRACTICAL MEDICINE. 

jfc Acidi carbolici gtt. x. 

Liq. ferri subsulph 3iij. 

Glycerinse Sj. — M. 

Sig. : To be applied every three to six hours with a camel's hair 
brush. — J. Lewis Smith. 

jfc Tin cturse ferri chloridi 3ii-iij. 

Potassii chlorat 3j. 

Acidi muriatici dil ...gtt. x. 

Syrupi simplicis Siv. — M. 

Sig.: A teaspoonful every hour or two. — J. Lewis Smith. 

DIPSOMANIA, 

Is a term commonly applied to an uncontrollable desire for 
alcoholic drinks. In cases of dyspepsia there may be a morbid 
craving for alcohol. The habitual drunkard feels a desire for 
continued indulgence, and lacks moral strength enough to govern 
an acquired appetite which represents a morbid condition. Dip- 
somania is to be treated as a disease of body and mind. The 
treatment consists in withdrawing the patient from the use of 
alcohol in any form, and in the employment of medicinal and hy- 
gienic measures. This morbid craving for alcohol is the sad 
inheritance from drunken parents (Flint). According to Ringer, 
ten -minim doses of tincture of capsicum obviate the morning vom- 
iting, remove the sinking at the pit of the stomach, the intense 
craving for stimulants, and promote appetite and digestion in 
dipsomaniacs. 

PRESCRIPTIONS FOR DIPSOMANIA, 

Jfc Tincturse capsici IHx. 

Potassii bromidi gr. x. 

Spiritus ammonise 3j- — M. 

Sig. : This to be taken at one dose, and repeated several times 
daily. 

Jfc Tincturse gentianse com p 

Tincturse columbse comp...aa Sij. 

Tincturse nucis vomicse XTLLxxx. — M. 

Sig. : A dessertspoonful before each meal. — Loomis. 



DIRT-EATING DROPSY. 155 

DIRT=EATINQ. 

Is a morbid habit which heretofore prevailed to a consider- 
able extent among the plantation negroes of the Southern States. 
The kind of earth selected is loam or clay. According to Dun- 
can, a very common disease among negroes on plantations is a 
state of anaemia, very often attributed to the pernicious habit of 
dirt- eating. Almost every large plantation has three or four 
such cases. With negroes, dirt- eating proceeds from the same 
propensity which leads white females to resort to chalk, mag- 
nesia, and slate pencils, etc., in order to relieve a disordered acrid 
condition of the stomach. Discover and treat the cause (Flint). 

DROPSY. 

Is an abnormal collection of watery fluid in the areolar 
tissue, or in the serous cavities of the body. Dropsy is not a 
disease, but a symptom. It is associated with various disorders. 
Dropsies may be external or internal. To internal dropsy be- 
long hydrocephalus, or dropsy of the brain, hydrothorax, or 
dropsy of the chest, and ascites, or dropsy of the abdomen. Ex- 
ternal dropsies are illustrated by anasarca and oedema: the first 
is a universal accumulation of serous fluid in the areolar tissues; 
the second, a localized collection in the same tissue, differing in 
nothing but extent. Both exhibit painless swelling of the sur- 
face, devoid of redness; a skin often stretched and shining, 
pitting upon pressure, and both, if punctured, allow a watery 
fluid to run out. (Edema is most commonly perceived around 
the ankles. Anasarca is usually dependent upon disease of the 
kidneys, or of the heart. The swelling ordinarily begins at the 
feet and ankles in diseases of the heart, in the face in disease of 
the kidneys. (Edema may be due to the same causes, or the 
cause may be purely local, as when we see oedema happening if 
a bandage be applied too tightly, or if swollen glands press 
upon the main vein of a limb. We see oedema in venous inflam- 
mation, in milk-leg, or as a sequel of typhoid fever, in conse- 
quence of the blocking up of the femoral vein by coagulum. In 
these cases, the oedema is one-sided. A circumscribed oedema, 



156 A COMPENDIUM OF PRACTICAL MEDICINE. 

also accompanies erysipelas of the skin. Another source of 
double -sided oedema is anaemia (DaCosta). 

Causes of General Dropsy. — The most common are diseases of 
the heart, of the kidneys, or of the liver. Cardiac dropsy begins in 
the feet and ankles. Renal dropsy is usually much more general 
than cardiac, and does not, like cardiac, begin in the most de- 
pendent parts, but is often first noticed in the face and eye -lids. 
The proof that dropsy is renal is furnished by the presence of 
albumin and casts in the urine. The most usual kind of dropsy, 
dependent upon an affection of the liver, is abdominal dropsy 
(DaCosta). 

. Dropsies may be divided into three classes : Inflammatory, 
mechanical, and cachetic or hydremic. Inflammatory dropsy is 
due to a moderate degree of inflammatory alteration in the coats 
of the blood vessels, and produces collateral oedema. Of this 
nature are cases of oedema glottidis, of hydrocele, and of hydro- 
cephalus. 

Mechanical dropsy is the result of some obstruction to the 
current of blood in the veins. The most frequent of the 
mechanical causes of general dropsy is valvular diseases of the 
heart. 

Hydrsemic or cachectic dropsy is the result of an impover- 
ished and abnormally watery state of the blood. The most 
important cause of hydrsemic dropsy is Bright's disease. 

PRESCRIPTIONS FOR DROPSY. 

|fc Spiritus chloroformi Vfi xx. 

Tinctune digitalis IH.x. 

Infusi buchu gj. — M. 

Sig. : To be taken three or four times daily, and followed by a 
good drink of water. (In renal dropsy.) — Fothergill. 

{fcr Infusi digitalis §iv. 

Sig. : A tablespoonful two or three times daily. — Bartholow. 

Jfc Potassii bicarbonatis gr. x. 

Ferri et amnion, citrat gr. v. 

Tincturae digitalis HI x. 

Infusi buchu §j. — M. 

Sig.: To be taken three times daily. (In cardiac dropsy with 
gouty tendency or debility. — Fothergill. 



DYSENTERY. 157 

DYSENTERY. 

Called also " bloody flux," is an ulcerative colitis. It is a 
disease characterized by tormina, tenesmus, mucus, and mucus 
and blood stools, burning pain, with more or less constitutional 
disturbance (Bartholow). 

Causes. — It occurs in both sexes and at all ages. Sudden 
arrest of perspiration by exposure to cold and dampness is one 
of the most common causes. It occurs in late summer and 
autumn and in warm rather than in a cold climate. It is preva- 
lent in malarious regions. Impure air and water, bad or insuffi- 
cient food are causes (Bartholow). 

Symptoms. — In the epidemic form, dysentery may begin 
suddenly, but in the other forms it comes on gradually. There 
is more or less catarrh of the intestines, diarrhoea, chilliness, 
fever, and a feeling of malaise. In two or three clays, pain in 
the descending colon is felt. It is described by the term tor- 
mina — "colicky pains." There is pain of a burning character in 
the rectum, with the sense of the presence of a foreign body, and 
with the desire to strain for its expulsion. Nothing comes away 
but mucus, either alone or tinged with blood. The tenesmus con- 
tinues. There may be ten to fifty stools daily. The patient 
becomes weak early. His skin is dry, harsh and wrinkled, his 
pulse small, quick and feeble. The discharges emit a horribly 
fetid odor. In the severe cases, the patient passes into the stage 
of collapse, the pulse ceases at the wrist, hiccough comes on, the 
skin is covered with a cold sweat, the hands become cold and 
livid, the face is shrunken, the eyes deeply sunk, and the voice 
husky. In mild cases convalescence is established about the 
eighth day. In the more severe cases, the duration is more pro- 
tracted (Bartholow). 

Prognosis. — Is good in mild cases, but in severe cases bad. 

Treatment. — 1. Food. If the stomach is irritable, milk, with 
one-fourth lime-water, is the best food. If the digestion remains 
good, the patient can take milk, eggs, beef -juice, ice- cream. 
boiled custard, oyster- soups, mutton, chicken and beef -broth. 
Where there is much depression of the powers of life, egg-nog 
may be freely given. 2. Medicine. According to Bartholow, 



158 A COMPENDIUM OF PRACTICAL MEDICINE. 

the sulphate of magnesia in solution with dilute sulphuric acid 
is entitled to the first place as a remedy. It must be given in 
laxative doses, early. It serves a triple purpose : it empties the 
canal of retained faeces, it lessens hyperemia by setting up an 
outward diffusion ; its after effect is astringent and sedative. 
Ipecac is an excellent remedy, and must be given in the first 
stage, before the mucous membrane is stripped off, and in scruple 
to drachm doses, every four to six hours. The first doses empty 
the stomach, and the following ones produce copious bilious 
evacuations, called "ipecac stools. " The utility of ipecac ceases 
when these stools are produced. It is best given in milk in 
twenty grain doses with aromatic powder added. Castor- oil, in 
purgative doses, in the first stage is very efficient. After the first 
stage is passed, an emulsion of oil (almond oil) and turpentine 
combined with opium is very serviceable. When destruction of 
the mucous membrane is beginning, the most effective remedies 
are corrosive sublimate, sulphate of copper, sulphate and oxide 
of zinc, acetate of lead, bismuth, arsenic, etc. Of this list, sul- 
phate of copper and arsenic, combined with opium, are most 
effective. One drop of Fowler's solution and five to twenty 
drops of deodorized tincture of opium, every three hours, gives 
excellent results. One -twentieth of a grain of sulphate of copper 
with one-eighth of a grain of morphine every three hours is good 
treatment (Bartholow). Bismuth in large doses (gr. xxx.-xl.) 
every four hours with carbolic acid is good. Excellent results 
are obtained by washing out the bowels with warm water. Very 
great relief is affected by the injection of starch and laudanum. 
Eight ounces of a strong solution of silver nitrate (gr. xx. to the 
ounce), thrown into the sigmoid flexure, is effective. Morphine 
hypodermically is effective. 

External Applications. — The cold, wet pack, the ice-bag, but 
generally hot applications afford more relief. The turpentine 
stupe is useful. If collapse comes on, active stimulation is neces- 
sary. 



DYSENTERY DYSMENORRHEA. 159 

PRESCRIPTIONS FOR DYSENTERY. 

|fc Tincturse opii deodorat gss. 

Bismuth subnitrat ^ij. 

Aquse menthse pip 

S yrupi zingiberis— aa gj . — M. 

Sig. : Shake bottle. Give one teaspoonful every two to four 
hours, to a child five years old. Half dose for a child one year old. 

— Smith. 

{i Vini ipecac ^ss. 

Sig. : One drop every hour. (In acute or chronic form of chil- 
dren, with slimy stools.) — Ringer. 

|fc Plumbi acetat gr. xxiv. 

Pulv. ipecac gr. iij. 

Pulv. opii gr. iij. — M. 

Ft. massa et in pil. no. xii. div. 
Sig. : One pill every two hours until blood ceases, then at longer 
intervals. — DaCosta. 

jfc Hydrargyri chloridi mitis 3J. 

In pulv. no. vii. div. 
Sig.: A powder two or three times daily. (In epidemic form.) 

—Hull. 

J& Cupri sulphatis gr. ss. 

Magnesii sulphatis §j. 

Acidi sulphurici dil 33. 

Aquse §iv, — M. 

Sig.: A tablespoonful every four hours. (In acute form.) 

— Bartholow. 

DYSMENORRHEA. 

Is painful menstruation. At the menstrual period women 
normally feel unwell, have a few vague pains in the loins, and 
an irritable temper. 

Varieties and Causes. — 1. Neuralgic or sympathetic dysnien- 
orrhoea is seen in nervous or hysterical women, and is accom- 
panied by neuralgia in other localities. 2. Congestive or innam- 
matory dysmenorrhoea occurs where there is excessive congestion 
of the uterus and ovaries from any cause. 3. Mechanical or 
obstructive dysmenorrhoea is due to some cause which mechani- 
cally obstructs the outflow of blood, as stenosis of the os uteri. 



160 A COMPENDIUM OF PRACTICAL MEDICINE. 

or sharp flexions. 4. Membranous dysmenorrhea is sometimes 
associated with endometritis. 5. Ovarian (Pozzi). 

Symptoms. — Pain occurs preceding, during, or following the 
menstrual flow. In the mechanical, the pain occurs with the 
appearance of the flow, and consists of a series of uterine cramps 
due to the effort of the uterus to expel blood clots from its in- 
terior. In the congestive, the pain precedes the flow, and is re- 
lieved when the latter becomes free. In the neuralgic, the pain 
is referred to the hypogastrium, left ovarian, and intercostal 
regions. It often occurs in the intermenstrual period, but is 
always aggravated at the time of the sickness. In the membran- 
ous, the pain lasts throughout the period, and until the expulsion 
from the uterus of the more or less complete membranous cast. 

Treatment.. — In the mechanical or obstructive, dilate the sten- 
osis, correct the flexion, and prevent its recurrence. In the con- 
gestive, give saline laxatives, hot foot- and sitz-baths, vaginal in- 
jections, and ergot, with bromide of potassium. Instead of the 
ergot and bromide, fifteen to twenty grain doses of phenacetine 
every six to eight hours may be given. In the neuralgic, let the 
patient exercise in the open air, and give, iron, quinine, and 
other tonics. Pozzi has found the tincture of pulsatilla, given 
some days before the period, in five-drop doses, three times daily, 
quite efficient in the neuralgic form of young women. In the 
membranous, dilatation of the cervix just before the menstrual 
period, is sometimes effective. In the ovarian type, the bromides 
are the most serviceable. In any variety, where the pain re- 
quires it, potassium bromide and chloral may be given, with 
mustard plasters applied. As palliative treatment for the pain, 
give asafcetida, musk, tincture of cannabis indica, belladonnae or 
hyoscyamus. Oxalate of cerium has been extolled. Wylie 
praises electricity, he inserts the positive pole in the cervix. 
Laudanum and valerian douches often afford relief when all 
other remedies fail. Nitro- glycerine and amyl nitrite are excel- 
lent for spasmodic cases (Pozzi). 



DYSMENORRHEA DYSPEPSIA. 161 

PRESCRIPTIONS FOR DYSMENORRHEA. 

R Tincturse cardamonii comp 3ss. 

Spiritus chloroformi XHxx. 

Liq. ammonii acetatis £ss. 

Tincturse belladonna ZTT.x. 

Aquae cinnamomi q. s., ad Sj. — M. 

Sig. : For one dose. (In congestive and spasmodic). — Pozzi. 

R Liq. ammonii acetatis ^iv. 

Sig.: A tablespoonful every two or three hours, with the fol- 
lowing: 

R Pulv. ipecac gr. iv. 

In pil. no. xii. div. 
Sig. : One every two or three hours. — Emmet. 

R Extracti opii gr. v. 

Extracti cannabis indica 

Extracti hyoscyami aa gr. x. 

Pulv. Camphoras gr. xxv. — M. 

Ft. massa et in pil. no. x. div. 
Sig.: A pill two or three times daily. — McLane. 

DYSPEPSIA. 

Is difficult or painful digestion. It is usually chronic. A 
disordered digestion, lasting for a short time, is called indiges- 
tion. 

Causes. — Dyspepsia is often an inherited condition. It may 
result from a deficiency in the quantity of gastric juice secreted, 
due to exhausting discharges, venereal excesses, masturbation, 
leucorrhcea and phthisis, and from the excessive use of narcotics, 
the tannin of tea, and the nicotine of tobacco. It may result 
from an excess in the gastric secretion, due to chronic hepatic 
and cerebral diseases, and to gout. It may result from a change 
in the quality of the gastric juice, due to ulcer and cancer of the 
stomach, gout, rheumatism, diseases of the kidneys, uterus and 
gall-bladder. Dyspepsia may result from pressure on the stom- 
ach by tight lacing, from positions assumed by shoemakers, 
needlewomen, writers, etc. It may result from mental emotion, 



162 A COMPENDIUM OF PRACTICAL MEDICINE. 

prolonged mental labor, anxiety, deficient or excessive physical 
labor, excess of starchy food, or from deficiency of meats, badly 
cooked food, too rapid eating, etc. (Loomis). 

Symptoms. — The most constant symptom is an abnormal 
ajjjjetite; it may be lost, increased, or perverted. There is a 
"weight, dull pain, and a sense of burning in the epigastrium 
after the ingestion of food, accompanied by flatulence, heartburn, 
gastralgia, constipation or diarrhoea, a dull headache, and languor. 
Indiscretion in eating or drinking is apt to bring on an attack of 
sick headache. There is frequently a bitter taste in the mouth. 
In some dyspeptics the breath has a very offensive odor. Py- 
rosis, palpitation, dyspnoea and a severe pain referred to the 
heart (which makes the patient think he has heart disease), may 
be present. In some cases there is ringing in the ears, spots 
before the eyes, and vertigo. When in any case the dyspepsia 
has lasted a long time, chronic gastric catarrh will almost always 
be developed (Loomis). 

Prognosis. — Dyspepia in most cases can be cured, but the 
cure depends for the most part on the will of the patient. 

Treatment. — First, if possible, remove the cause. When the 
gastric juice is deficient in quantity, hydrochloric acid and pepsin 
are indicated. The vegetable bitters are efficient in these cases, 
and may be combined with alcoholic stimulants. When acid 
risings occur after ingestion of food, and are due to active fer- 
mentation, the sulphite of soda, or salicylic acid immediately 
after meals may prevent such changes. Saline waters will aid. 
When there is great irritability of the stomach, bismuth acts 
almost as a specific, and should be given in twenty grain doses 
before eating. Creosote, codeia, oxalate of cerium, and morphia 
may be employed to arrest vomiting. Dyspeptics should never 
wear corsets or belts about the abdomen. They should retire 
and rise early, eat slowly, and masticate well. No mental or 
physical work should be performed directly after or before 
eating. Horseback riding and walking in the open air should 
be insisted upon. A change of scene and climate works rapid 
cures in many instances. Dyspeptics should take a cold sponge- 
bath morning and evening (Loomis). A small quantity of acid 
wine at dinner is a good stimulant to the digestive function. A 



DYSPEPSIA. 163 

moderate close of whiskey, taken before meals, is a capital remedy 
to promote the appetite and the digestion (Bartkolow). 

PRESCRIPTIONS FOR DYSPEPSIA. 

R Ammonii salicylates 3ij- 

Syrupi aurantii cort §j. 

Aqua? menthee pip ad 3iv. — M. 

Sig. : A tablespoonful half an hour before meals. (In fermentative 
dyspepsia.) — Sullivan. 

R Tincturae capsici IH.xvj. 

Tincturae nucis vomicae ..^ij. 

Tincturae gentianae comp ad...3ij. — M. 

Sig. : A teaspoonful in water three times daily, with -i- gr. aloin 
at bedtime, avoiding starchy diet. (For aggravated dyspepsia with 
constipation.) — DaCosta. 

R Bismuthi subnitratis 

Sodii bicarbonatis 

Pul v. cubebae — aa 3j . 

Pulv. zingiberis gr. xx. — M. 

In pulv. no. xii. div. 
Sig. : A powder in a wineglassful of water before each meal. 

—Clark. 

R Tincturae opii deodorat gtt. xij. 

Magnesii calcinat gr. xij.-xxiv. 

Sacchari albi 3j. 

Aquae anisi giss. — M. 

Sig. : Shake bottle. One teaspoonful every two hours to a child 
one year old, until relieved. — J. Lewis Smith. 

R Bismuthi subnitratis ^iss. 

Mucil acaciae 5J. 

Sodii bicarbonatis 3iss. 

Infusi calumbae ad §viij . — M. 

Sig.: Two tablespoonfuls before meals. (Irritative dyspepsia 
with raw tongue.) — Fothergill. 

Buttermilk -cure may be substituted for the milk- cure in 
cases of stomach disease (Bartholow). 

Actaea (cimicifuga) is recommended for the dyspepsia of 
drunkards. 



164 A COMPENDIUM OF PRACTICAL MEDICINE. 

DACTYLITIS. (Syphilitic). 

Is gummy in character, and hence belongs to the later stages 
of syphilis. It is a rare affection. The swelling usually termin- 
ates abruptly, and is sometimes very great. There is no com- 
plaint of pain. The skin is natural or bluish from venous 
obstruction. 

Treatment. — Is that of tertiary syphilis. 

DANDRUFF. (See Pityriasis). 
DERBYSHIRE NECK. (See Goitre.) 

DROWNING. 

Remove from the mouth and nostrils all obstructions to the 
free passage of air to the lungs ; loosen clothing about the chest. 
Extend the arms in the direction of the body above the head, 
and when the capacity of the chest is thus enlarged, throw fresh 
air into the lungs by a flexible tube passed into the trachea, and 
then rej3lace the arms, pressing firmly upon the sides and 
sternum. These motions may be repeated ten or fifteen times 
per minute. A strong solution of ammonia may be passed under 
the nose. 

EARACHE. 

Treatment. — An excellent application in earache is the fol- 
lowing: 

R Morphia sulphatis gr. iv. 

Aquae destillatse Sj. — M. 

Sig. : Fill the external meatus with the solution. — Bartholow. 

Cocaine, five to ten per cent, solution, is the most effective 
remedy for earache (Bartholow). 

The external auditory meatus filled with water as hot as can 
be borne is effective. 

Counter -irritation by blistering fluid or croton-oil liniment 
behind the ear often removes earache (Ringer). 



ECZEMA. 165 

ECZEMA. 

Is a non-contagious, vesicular, cutaneous eruption, with 
oedenia, pustules, exudation, or fission, and usually much itching. 
Eczema is catarrh of the skin (Tilbury Fox). It may safely be 
affirmed that very few persons pass through life without suffering 
from it in some measure. It is by far the most frequent of the 
diseases of the skin. 

Causes. — May be constitutional or local, or both combined. 
It often happens that the constitutional cause has disappeared 
before the patient is seen, and the affection remains, owing to 
the skin having contracted a bad habit. The chlorotic, the rach- 
itic, the scrofulous, and the debilitated, are very liable to be at- 
tacked. Eczema may be caused by digestive derangement, and 
the parts most frequently attacked are the face, lips, arms and 
hands. Improper, insufficient or bad food, is very apt to call it 
forth. It is often seen in infants whose mothers have a deficient 
or watery secretion of milk. A fruitful cause of eczema is de- 
ficient excretion, constipation, or defective elimination by the 
kidneys. A predisposing cause is rheumatism. Diabetes niel- 
litus may cause an eczema of the genital organs. Long- continued 
mental excitement, anxiety, grief, or over -study, may cause it. 
Eczema is met with at all periods of life, but occurs most fre- 
quently in children. Derangement of the uterus or its append- 
ages, irritation of ascarides, or tapeworm, stricture of the urethra, 
dentition, internal medicines, exj3osure to great heat, or to ex- 
treme cold, or to acrid substances (as in the case of grocers, 
bakers, bricklayers, washerwomen, cooks, smiths, etc.), may 
cause eczema. Varicose veins, pressure by tumors, garters, and 
trusses, stimulating liniments, as croton-oil, lice, fieas, bugs, irri- 
tation of the razor, and of discharges from the genito- urinary 
organs, anus, meatus auditorius, nostrils and mouth, are common 
causes of eczema. The irritation of poisonous dyes used in 
some of the colored socks in the market, is apt to give rise to a 
variety of eczema of the feet. 

Symptoms. — There are four symptoms which are almost in- 
variably present to a greater or less extent, namely: 1. Infiltra- 
tion of the skin. 2. Exudation on the surface of the skin. 3. 



166 A COMPENDIUM OF PRACTICAL MEDICINE. 

Formation of crusts. 4. Burning heat, or itching. The infiltra- 
tion is due to the transudation of serum from the blood-vessels 
into the tissues, The exudation, or "weeping" may take place 
constantly, or at intervals; it is then called moist eczema. If 
there is no exudation, it is called dry eczema. The crusts, com- 
posed of hardened exudation, are more or less present. If the 
patient be cleanly in his habits, the exuded matter is washed off, 
and the crusts may be wanting; and, vice versa, the crusts may 
be thick. When the patches of eruption are acutely inflamed, 
burning heat is complained of. When the disease becomes 
chronic, the burning heat is replaced by itching. The use of 
stimulating food or drink, or on getting warm in bed, or the 
slightest touch of the part, gives rise to an irresistible desire 
to -scratch. Patients derive much positive pleasure from scratch- 
ing the part. Instead of itching, formication is sometimes com- 
plained of. Scratching always aggravates the disease. The 
elementary lesion is of great importance. This may be: 1. An 
erythematous state of the skin. 2. A vesicle. 3. A pustule. 
4. A papule, or a mixture of all these lesions. When the ele- 
mentary lesion is an erythematous state of the skin, the disease 
commences as a simple inflammatory redness of the surface, with- 
out, at first, infiltration or exudation. The vesicular and pustular 
forms of eczema often form upon an erythematous ground. 

Prognosis. — Is rarely serious. Attacks of eczema vary much 
in their duration. Some cases get well without treatment in a 
few weeks, others last for months or even years. When the 
eruption is localized it is more difficult of cure. Relapses are 
very much to be feared. 

Treatment. — Some cases may be cured by either constitu- 
tional or local treatment, but generally it is advisable to employ 
a combination of both. 

Constitutional Treatment. — Purgatives and aperients are often 

useful, but are merely aids to other treatment. If the tongue is 

loaded, the appetite bad, the liver torpid and the bowels costive, 

the following formulae may be used : 

U Hydrargyri chloridi mitis gr. xx. 

Pulv. scammonii comp gr. xL. — M. 

Div. in pulv. iv. 
Sig. : One every week. — Anderson. 



ECZEMA. 167 

B Quinise sulphatis gr. xij. 

Pulv. rhei gr. xxxvj. 

Hydrarg. cum cretse , gr. xx. 

Sacchari purificati gr. xx. — M. 

In pulv. no. xii. div. 
Sig. : Two daily. The dose to be so regulated that the patient 
has at least one full natural evacuation per day. Or the following 
may be given : 

R Quiniae sulphatis gr. xLviij. 

Ferri sulphatis ^iij . 

Acidi sulphurici dil 3iss. 

Magnesii sulphatis 5iij . 

Syrupi zingiberis 

Tinct. aurantii — aa §iss. 

Infusi calumbae. ...... ad ^xxiv. — M. 

Sig. : A tablespoonful in a wineglassful of water thrice daily. 

Iii some cases of eczema, diuretics are indicated. In strum- 
ous subjects, nourishing food, stimulants in moderation, and 
tonics are our sheet anchors. Severe cases of eczema have been 
cured by the administration of cod- liver oil and syrup of the 
iodide of iron. Twenty drops of the syrup of iodide of iron in 
a teaspoonful of cod- liver oil thrice daily, and the dose to be 
gradually increased to a tablespoonful, may be given. Cod- liver 
oil may be applied locally with benefit. Of nerve tonics, those 
which are most likely to be useful are strychnia and arsenic (in 
form of Fowler's solution). In chronic eczema, electricity is 
used with some benefit. The diet is of great importance, and 
must be carefully regulated. 

Local Treatment. — Some cases of eczema are local diseases 
throughout their whole course, being due to local irritation, and 
are benefited more by local than constitutional treatment. The 
disease sometimes remains from habit. Our skins have the same 
tendency as ourselves to contract bad habits. The first thing is 
to remove the crusts with oil. Then dust the parts with absorb- 
ent powder two or three times daily. Soothing ointments are 
indicated, such as follows : 

R Zinci oxidi 3J. 

Acidi oleici §viij . 

Vaselini §ix. — M. 

Sig.: Apply to parts. — Anderson. 



168 A COMPENDIUM OF PRACTICAL MEDICINE. 

R Pulv. camphorae gr. xx. 

Pulv. zinci oxidi gij. 

Glycerini 3 # j. 

Adipis benzoati §j . 

Cochinillini .. gr. j. 

Olei rosse ...ZR.j— M - 

Sig. : Apply to face two or three times daily. —Anderson. 

R Hydrargyri perchloridi gr. xij. 

Acidi hydrocyanici dil gij. 

Glycerini... giij . 

Eau de cologne ad ^vj. — M. 

Sig.: Sponge the parts two or three times daily. — Anderson. 

Of "all the local means for the removal of limited eczematous 
eruptions, none are superior to blistering. The best and safest 
blistering agent is cantharides. The local varieties of eczema 
are: of the head, hairy portions of the face, lips, edges of the 
eyelids, nostrils, auricle, and external auditory passage, the flexor 
surfaces of the joints, the hands and feet, the legs and the geni- 
tal organs. 

PRESCRIPTIONS FOR ECZEMA. 

R Acidi citrici gr. xv. 

Aquae lauro-cerasi 5) . 

Olei rusci (birch) gtt. xv. 

Ungt. aquae rosse 3x. — M. 

Sig. : Use thrice daily. Use starch powder between the applica- 
tions. Carefully attend to diet. (For acute eczema.) — Monin. 

R Glyceriti amyli ^viiss. 

Acidi tannici 

Hydrargyri chlo. mit aa gr. xv. — M. 

Sig.: Apply morning and evening. (In dry eczema with 
itching.) — Vidal. 

R Ungt. hydrargyri oxidi rubri gij. 

Ungt. sulphuris 31J. 

Acidi carbolici gr. iij. 

Unguenti simplicis ^ss. — M. 

Sig.: Apply to the affected parts. (In chronic eczema.) 

— DaCosta. 

R Tincturae belladonnas ^ss. 

Sig.: Five drops thrice daily to a child of two years. (In in- 
fantile eczema.) — Bartholow. 



ECZEMA — EMISSIONS. 169 

R Pulv. acidi salicylici gr. xv.-xxx. 

Pulv. zinci oxidi 

Pulv. amyli aa ^iij. 

Vaselini pari £vj . — M. 

Ft. iingt 

Sig. : Apply locally, and cover with cotton after rubbing oint- 
ment in. (In papulous or squamous eczema.) — Lassar. 

R Infusi cinchonse ^vj. 

Aquae calcis ^ixss. 

Tinct. lupulinae 

Succi conii aa £ij. — M. 

Sig. A wineglassful thrice daily. (In chronic eczema of the 
aged.) — Neligan. 

R Ferri et ammonii citratis 3J. 

Potassii citratis gij. 

Liquor potassii arsenitis 3!— ij . 

Tinct. nucis vomicae gij. 

Tinct. cinchonae comp ad ^iv. — M. 

Sig.: A teaspoonful in water after meals, as a tonic and altera- 
tive. (In eczema.) — Bulkley. 

R Resorcin 

Zinci oxidi aa 3j. 

Ungt. aquae rosse ^x. — M. 

Ft. ungt 

Sig. : Apply locally. (In chronic indurated eczema of infants.) 

— Fleisburg. 

EMISSIONS. (Involuntary Seminal.) 

By involuntary seminal emissions is meant the ejaculation 
of semen and the venereal orgasm without any voluntary effort, 
either natural or unnatural. 

Involuntary emissions occurring during sleep are common, 
taking place with erotic dreams. Occurring after intervals of 
several days in persons of continent habits, they are physiologi- 
cal rather than pathological. They denote simply a certain 
amount of functional activity of the generative organs. They do 
not imply a morbid condition nor do they lead to any morbid 
effects. They occur especially when habitual sexual intercourse 
is interrupted from any cause. Under these circumstances they 
are manifestations of health rather than of disease. 



170 A COMPENDIUM OF PRACTICAL MEDICINE. 

Occurring more frequently, the emissions denote a morbid 
erethism and weakness of the organs of generation. They occur 
sometimes nightly and sometimes even repeatedly during the 
same night. They then call for remedial measures. 

Occurring in persons debilitated from any cause, they may 
take place without any erection and with little or no venereal 
excitement. They occur sometimes during the day, and are called 
diurnal. Venereal excesses, or unnatural abuse, are the causes of 
this morbid frequency. The mind becomes depressed. The 
patient fancies he is impotent, his constitution ruined, and that 
there is danger of insanity. They go from one physician to an- 
other, and upon patients of this class quacks prey largely (Flint). 

Pollution is a term applied to involuntary seminal emis- 
sions, attended by venereal orgasm, more or less marked. Dr. 
Keyes writes as follows of pollution : " Nocturnal pollutions 
are exceedingly common. They usually accompany erotic 
dreams." 

Nocturnal emissions in moderation are entirely natural, and 
by no means a sign of disease. Their frequency compatible 
with health varies with the purity of mind and sexual vigor of 
the patient. A man who is happily married rarely has noctur- 
nal emissions while living with his wife, but, if he leaves her for 
several weeks, it is natural and entirely the rule that there 
should be a formation and collection of semen, which distending 
the seminal vesicles, excites erotic fancies, and escapes at the 
conclusion of a dream. Any man suffering from ungratified 
sexual desire is normally in a condition demanding relief for his 
over distended seminal vesicles, and, if that relief be not afforded 
in some way by the patient, it will come spasmodically during 
sleep. Occasionally nocturnal emissions may be over-frequent, 
and indicate a condition of irritation in the deep urethra which 
requires treatment (Keyes). 

Treatment. — When emissions do not exceed three times 
weekly they should be disregarded. Where they become very 
frequent, as nightly or several times a night for a considerable 
time, there should be an attempt made to correct the habit. 
Purify his thoughts, elevate his tone, and get him if possible 
happily married. The patient should endeavor to sleep soundly 



EMISSIONS. 171 

by tiring himself out through the clay by physical work. Dry 
friction, cold bath and cold douche locally are useful. He 
should sleep on a hard bed lightly covered. The stomach should 
not be full on retiring. Lying on the back with the bladder full 
of urine, tends to beget erections. To avoid this, the patient 
should tie a towel around his waist on retiring, with a hard knot 
in the back over the spine. Besides the above means, bromide 
of potassium, camphor and lupulin may be given internally, 
with strychnine and a mineral acid, and locally decided advan- 
tage may be derived from the gentle use of the steel sound, as in 
neuralgia of the vesical neck. Mechanical devices appear from 
time to time for treating pollution, but they usually do more 
harm than good. Keyes used an appliance which started a 
battery and gave an electric shock in the back when erection 
came on. Verneuil used a similar instrument which caused a 
bell to ring when erection came on. A ring which lightly encir- 
cles the penis, but when distended by erection causes pain and 
awakens the patient has been used. Marriage is always remedial 
in physiological cases (Keyes). 

PRESCRIPTIONS FOR EMISSIONS. 

R Potassii bromidi 5j . 

Sodii bicarbonatis gr. xv. 

Infusi digitalis §ss. 

Atrophias sulphatis gr. q\. — M. 

Sig. : To be taken at bedtime. — Gross. 

R Lupulinas ...... .gr. x. 

Pulveris camphorse gr. vj. 

Extracti belladonnas gr. ij. — M. 

In pil. no. xii. div. 
Sig.: One pill thrice daily. — Bartholow. 

R Tincturas cantharidis ^ij. 

Tincturae ferri chloridi gvj. — M. 

Sig.: Twenty drops in water thrice daily. — Wood. 



172 A COMPENDIUM OF PRACTICAL MEDICINE. 

EMPHYSEMA. (Pulmonary.) 

Emphysema in general signifies the presence of air in the 
interstitial connective tissue. In the lungs, however, there are two 
kinds of emphysema — interlobular and vesicular; the former 
arises from rupture of the air-cells, causing a communication be- 
tween them and the interlobular connective tissue, and the latter, 
the more common, consists in an abnormal accumulation of air 
within the air-cells. 

Emphysema is essentially a chronic affection; it comes on 
slowly, and when once developed is permanent (Loomis and 
Flint). 

Causes. — Are forced expiratory efforts, the glottis being 
closed or narrowed, as in violent coughing, straining at stool, 
etc. It is developed in the upper lobes of the lung. Various 
injuries and diseases of the chest which limit the movements of 
the lungs, as curvature of the spine, pleural adhesions, hydro- 
thorax, tumors, pneumonia, perforating wounds of the chest, or 
injury of the lung by the extremity of a fractured rib, may 
cause emphysema of the lung (Loomis and Flint). 

Symptoms. — The most prominent and constant subjective 
symptom of emphysema is dyspnoea, which is increased by physi- 
cal exercise. It is worse during the cold of winter. There is 
often a smothering sensation in the chest. There is no fever. 
The pulse is feeble, and the body cool and cyanotic. In extreme 
cases, lividity is marked. Usually there is no pain in the chest. 
The nostrils are distended, the voice is feeble, and the capillary 
circulation is imperfect. The temperature of the body is usually 
sub-normal. There is distension of the jugular veins, and ver- 
tigo is common. There may be oedema of the feet and ankles. 
Emphysematous patients are especially liable to hemorrhoids. 

Physical Signs. — On inspection, it will be noticed that the 
chest is "barrel- shaped.'" The lower portion of the chest seems 
contracted. The apex of the heart will be found beating lower 
down than normal, and more toward the median line. On pal- 
pation, the vocal fremitus, varies. In senile emphysema, the vocal 
fremitus is usually increased. The percussion sound is vesiculo- 
tympanitic. On auscultation, the inspiratory sound is either 



EMPHYSEMA EMPYEMA. 173 

short or feeble, or actually suppressed, while the expiratory is 
greatly prolonged (Loomis). 

Prognosis. — It rarely, if ever, destroys life, but when once 
developed, is never recovered from. 

Treatment. — As this disease is incurable, our treatment must 
be palliative. Iron and the sulphate of quinine in small doses, 
may be given with benefit. Cod -liver oil, bitter infusions, min- 
eral acids and stimulants are all useful. The diet should be of 
the most nutritious character, and composed largely of animal 
food. Exercise in the open air should be taken. Quebracho is 
a useful drug for emphysema. For the bronchitis which accom- 
panies emphysema, iodide of potassium in five to ten grain doses 
thrice daily is serviceable. For the asthmatic attacks, morphine 
and atropine are useful. 

PRESCRIPTIONS FOR EMPHYSEMA. 

R Liquoris potassii arsenitis gtt. ij. 

Potassii iodidi gr. x. 

Syrupi tolu 5ss. 

Aquae 5ss. — M. 

Sig.: This dose t. i. d. 

R Ammonii iodidi 5j- 

Liquoris potassii arsenitis 5ss. 

Syrupi tolutan Sj ■ — M. 

Sig.: A teaspoonful every four hours. — Bartholow. 

EMPYEMA. 

Called, also, suppurative pleurisy, or pyothorax, is charac- 
terized by the accumulation of a purulent liquid in the pleural 
cavity. It is usually confined to one side. 

Cause. — Is not always known. It may be of traumatic ori- 
gin. It may result from exhausting diseases or debility. It often 
complicates acute and chronic infectious diseases. Chronic tuber- 
cular pleurisies are very apt to be suppurative in character. It 
may be secondary to abscess of the liver, or in the abdominal 
cavity, or to chronic phthisis. It is sometimes secondary to Lobar 
pneumonia (Loomis). 



174 A COMPENDIUM OF PRACTICAL MEDICINE. 

Symptoms. — If the inflammatory process is acute there will 
be chills, fever, a rapid pulse, severe pain in the affected side, 
great prostration, anxious expression and typhoid symptoms ; 
these cases usually terminate fatally within two or three weeks. 
The symptoms of chronic empyema are very often obscure. The 
patient rarely suffers from local pain — there is simply a sense of 
uneasiness, or weight in the affected side, loss of flesh and 
strength, pale countenance, diurnal chill followed by profuse 
sweats. There are cough, weak voice, dyspnoea, etc. A positive 
diagnosis may be made by an exploratory puncture. If an em- 
pyema is about to open externally, it will protrude between the 
ribs, and give a sense of fluctuation, and become red. It may 
open into a bronchial tube and be followed by profuse purulent 
expectoration. The chest walls gradually retract. It may open 
into the peritoneal cavity and be followed by a fatal peritonitis 
(Loomis). 

Prognosis. — Unfavorable. 

Treatment. — An opening should be made at the bottom of 
the pleural sac, allowing the pus to escape freely. The pleural 
cavity should be daily cleansed by the injection of tepid water 
to which a very small quantity of carbolic acid (one per cent.) is 
added. Aspiration should first be tried. In children simple 
aspiration frequently effects a cure (Flint). If aspiration is re- 
sorted to, a large -sized needle should be used, and only a small 
portion of the fluid removed the first time. Aspirate every third, 
fourth or fifth day. Never continue the removal of pus in em- 
pyema after the patient complains of constriction in breathing. 
If a permanent opening is to be made, let it be made in the ax- 
illary line in the seventh or eighth intercostal space, and a 
quarter -inch rubber drainage tube should be introduced, and so 
fastened that it will remain. The pleural cavity should not be 
washed out (Loomis). Tonics, such as quinine, cod- liver oil 
and iron are always indicated and exercise in the open air. 

PRESCRIPTIONS FOR EMPYEMA. 

R Misturse ferri et amnion acetat 51 v. 

Sig.: One to two teaspoonfuls four times daily, with quinine and 
stimulants. (In chronic cases.) — DaCosta. 



ENDOCARDITIS. 175 

R Liquor iodinii comp... 5j. 

Aquse destillatse §xv. — M. 

Sig. : Inject after aspirating the pus. — Bartholow. 

R Quinise sulphatis ^ij. 

Aquse §xij. — M. 

Sig. : Inject after evacuating the pus. — Ringer. 

R Aquae chlorinii gj. 

Aquae destillatse ^ix. — M. 

Sig.: To wash out the pleural cavity after the evacuations of 
the pus. — Ringer. 

ENDOCARDITIS. 

Is an inflammation of the endocardium. In adults the left 
heart is oftenest affected. The inflammation is, in the majority 
of cases, situated on the valves and chordae tendineae. Vegeta- 
tions appear upon the endocardium. These vegetations may 
attain the size of a pea and are favorable points for the detach- 
ment of emboli (Flint). 

Causes. — Primary, or idiopathic endocarditis is extremely 
rare. It is secondary to pleuritis, pneumonia and pericarditis, 
but, very more frequently, secondary to acute rheumatism. About 
one -third of the cases of acute rheumatism are complicated by 
endocarditis (Bartholow). It is produced by the same cause 
that produced the rheumatism, and not by metastasis (Flint). 

Symptoms. — The patient may complain of an obscure sense 
of distress in the prgecordia, not amounting to pain. The action 
of the heart may be morbidly excited — palpitation. There is an 
endocardial murmur. The murmur is of a soft, or bellows char- 
acter. It accompanies the first sound of the heart. It is heard 
loudest at or near the apex of the heart (Flint). There may 
be paroxysmal dyspnoea, the face may be flushed and even cyanotic 
(Loomis). 

Prognosis. — The danger is not immediate, but remote. 

Treatment. — Sinapisms and stimulating liniments to the 
praecordia are indicated. Alkaline remedies lessen the liability 
to fibrinous deposits upon the valves. The patient should avoid 
physical exertion, mental excitement, a stimulating diet, and the 
use of alcohol. A tablespoonful of the infusion of digitalis 
should be given every four hours (Flint and Bartholow). 



176 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR ENDOCARDITIS. 

R Tincturse digitalis Sj. 

Sig. : Ten or fifteen drops every four hours. (When heart's ac- 
tion is irregular). — DaCosta. 

R Tincturse aconiti radicis Sss. 

Sig. : One drop every hour or two. — Ringer. 

R Lini farinse 

Aquae bullientis aa q. s. — M. 

Ft. cataplasma. 
Sig. : Apply over the heart as hot as can be borne. — DaCosta. 

ENTERITIS. 

Is a general term applied to a catarrhal inflammation of the 
intestinal mucous membrane. It may be acute or chronic. 

Causes. — Direct irritation of the mucous membrane by im- 
proper, or decomposing food, impure water, or irritating medi- 
cines, or by exposure to wet or cold, will cause intestinal catarrh. 
Extensive burns will cause it. Chronic malarial infection, and 
chronic Bright's disease may cause it. Predisposing causes are 
cirrhosis of the liver, chronic valvular lesions, and pulmonary 
emphysema. It occurs at all ages. The two great predisposing 
causes in children are dentition and bad hygiene during the hot 
months (Loomis). 

Symptoms. — Diarrhoea is its earliest and most constant symp- 
tom. Watery mucus may be discharged from the bowels, or 
there may be bilious diarrhoea, with pains and cramps in the 
calves of the legs, vomiting, headache, furred tongue, and green- 
ish stools. Serous diarrhoea is the most common, and at first the 
dejections contain undigested food. There is pain, colicky and 
griping in character, or it may be dull. Food increases the pain. 
There is a sense of fullness and distension of the abdomen, and 
tenderness on pressure. There are flatulence and gurgling. 
Nausea and vomiting indicate that gastric catarrh is associated 
with the intestinal. There is usually a mild, remittent type of 
fever, with Joss of appetite, offensive breath, scanty and dark 
urine. Thirst is intense (Loomis). 



ENTERITIS. 177 

Treatment. — Keep the patient in bed. It is safe to begin the 
treatment in every case of acute intestinal catarrh by the admin- 
istration of castor oil. The diet should consist of milk with 
lime-water. The yolk of eggs may be given with the milk. 
Prepared meats and light broths are useful. No fats should be 
allowed, or bread or any form of starchy food. Stimulants may 
be given when there is prostration. The abdomen should be 
covered with warm fomentations. Opium is the most efficient 
agent and must be given in half grain doses every two or three 
hours. When the catarrh is of malarial origin, quinine must be 
given in large doses. If it is the result of exposure to wet and 
cold, diaphoretics are indicated. Chronic intestinal catarrh may 
be treated by astringents; the best are nitrate of silver, acetate 
of lead, and sulphate of copper. Sponging the abdomen with 
cold salt water is good (Loomis). 

PRESCRIPTIONS FOR ENTERITIS. 

R Pulv. ipecac comp gj. 

Bismuthi subnitratis gij. — M. 

In pulv. no. xxiv. div. 
Sig. : A powder every two to four hours for a child five years old. 

— J. Lewis Smith. 

R Pulv. opii gr. v. 

Bismuthi subnitratis ^ij. — M. 

In pulv. no. xx. div. 
Sig. : A powder every two to four hours for a child five years old. 

— J. Lewis Smith. 

R Liq. potassii arsenitis gtt. L. 

Tincturae opii 3j . 

Aquae ad giij. 

Sig. : A teaspoonful before meals thrice daily. (In chronic and 
malarial form.) — Bartholow. 

R Tinct. opii deodorat 3j. 

Sig.: Ten drops every second or third hour, according to age, to 
the point of tolerance. — DaCosta. 



178 A COMPENDIUM OF PRACTICAL MEDICINE. 

EPILEPSY. (Falling Sickness. ) 

Is a chronic paroxysmal affection. The paroxysms are char- 
acterized by loss of consciousness and convulsive movements of 
the muscles. Convulsions similar to those of epilepsy are symp- 
tomatic of different cerebral affections, of anaemia, of injuries of 
the head, and of strychnia, and are distinguished as epileptiform. 
Epilepsy is a functional affection. In the majority of cases, the 
loss of consciousness is as sudden as if produced by a stunning 
blow upon the head, and the person falls. In a minority of 
•cases, there is a brief warning of the approaching fit. It is a 
;sense of a "cold vapor" emanating from some part of the body 
and mounting to the head, and has been called the aura epilep- 
tica (Flint). 

Cause. — Thirty per cent, of epileptics give a history of an 
inherited tendency. Children of consanguineous marriages are 
often epileptics. It most frequently develops between the ages 
of ten and twenty. Puberty and injury to the peripheral nerves, 
the skull, meninges, and diseases of the brain substances are ex- 
citing causes. It may arise from irritation of the genital organs, 
anomalies of menstruation and phimosis (Loomis). It is very 
generally believed that the immediately exciting cause of an epi- 
leptic paroxysm is cerebral anaemia resulting from vaso- motor 
spasm. Venereal excesses, and habits of masturbation have 
been supposed to be frequent causes. Flint relates the case of a 
female patient who experienced the first paroxysm during the 
first act of sexual congress after marriage. Subsequently, a 
paroxysm occurred at each marital connection, and she became a 
confirmed epileptic. It is well known that dogs, cats and other 
domestic animals are liable to epilepsy (Flint). 

Symptoms. — (Of grand mal.) — The onset of the paroxysm is 
often marked by a loud, sharp cry, and the epileptic falls heavily. 
Drawing the head toward one shoulder is sometimes a warning 
of an epileptic seizure. There is complete loss of consciousness. 
The face is extremely pale. The pupil is invariably dilated at 
the onset and does not contract on exposure to bright light and 
the eyes are fixed and staring, and the muscles of the face, trunk 
and extremities are rigid. Opisthotonos may occur. The face 



EPILEPSY. 179 

soon becomes dark from asphyxia. Clonic convulsions succeed 
the tonic spasms. The tongue is thrust between the teeth. The 
teeth are sometimes broken. The patient froths at the mouth, 
and from the injuries to the tongue the saliva is often bloody. 
The body is often bathed in a profuse sweat. The fit may ter- 
minate suddenly or gradually. The patient has no recollection 
of the attack, and appears as if waked out of a deep sleep. 

(Of petit mal). — There is momentary loss of consciousness, 
the patient suddenly stops; has a fixed gaze for a second or two, 
his mind is confused, and then proceeds as if nothing had hap- 
pened. There may be nocturnal attacks of epilepsy. The only 
evidence of these attacks may be the tongue which shows indents 
of the teeth, and the pillows may be blood-stained. 

Number of Fits. — The first fit may also be the last. They 
may occur once a year, or two or three times in twenty -four 
hours. In women it sometimes seems to be connected with the 
menstrual epoch. Eighty per cent, of all epileptics are attacked 
oftener than once a month. 

Results of Epilepsy. — There may be impairment of the mental 
or physical condition. Of the mental faculties, memory is most 
often impaired. A subnormal temperature is very common 
(Loomis). 

Treatment. — When an epileptic fit is once established there 
is little to be done but to prevent the patient from injuring 
himself. Try to discover the cause and remove it. The bromides 
are at the pre&ent time used more than any other remedies. Cod- 
liver oil is useful. Nearly all the drugs of the materia medica 
have been tried (Loomis). 

PRESCRIPTIONS FOR EPILEPSY. 

R Ferri bromidi gr. iv. 

Potassii bromidi 5J . 

Syrupi simplicis 31J . 

Aquse ad gviij . — M. 

Sig. : A tablespoonful twice daily. (In anaemic patients.) 

— Bartholow. 

R Extracti conii fluidi (Squibbs)....§ij. 
Sig.: Fifteen to sixty minims three times daily. — Spitzka. 



180 A COMPENDIUM OF PRACTICAL MEDICINE. 

R Lobelinse hydrobromat gr. ^-j. 

Aquae destillatse Siiss. — M. 

Sig. : A teaspoonful three or four times a day. — Bartholow. 

R Potassii bromidi ,,,, 

Sodii bromidi 

Ammonii bromidi aa oiij . 

Potassii iodidi 

Ammonii iodidi aa 5iss. 

Ammonii carbonat 5j. 

Tincturse calumba? Siss. 

Aquae q. s., ad. ft Sviij. — M. 

Sig.: A teaspoonful and a half before each meal, and three at 
bed time. — Brown-Sequard. 

EPISTAXIS. 

Is nasal hemorrhage. 

Causes. — The mucous membrane of the nose is full of blood 
vessels, and bleeds easily. It may be caused by ulceration of the 
membrane, by vascular tumors, and by mechanical causes, as 
valvular disease of the heart (Bartholow). 

Symptoms. — There may be a sense of fullness of the head, 
headache, noises in the ears, and vertigo. The blood may come 
drop by drop from a single nostril, or from the posterior nares. 
The quantity of blood discharged varies; it may be an ounce or 
even a pint or quart. Epistaxis may occur periodically as a 
manifestation of malaria, or take the place, vicariously, of the 
menstrual or hemorrhoidal flux (Bartholow). 

When the bleeding occurs in sleep from the posterior nares,. 
and is swallowed, there may be, if vomiting of the blood occurs,, 
much difficulty in ascertaining the true source (Bartholow). 

Treatment. — Small pellets of ice may be introduced into the 
nares, while a block of ice, hollowed out to fit the nose, may be 
put on outside. Simply pressing the nares together, to enable 
the blood to coagulate, may often suffice. If pressure and cold 
fail, a solution of tannic acid, or of alum, or of acetate of lead, 
may be thrown into the nares, and. if these fail, a solution of 
MonseFs salts. All other expedients failing, the posterior nares 
must be plugged (Bartholow). 



EPISTAXIS ERYSIPELAS. 181 

Small doses of aconite, given frequently, will often quickly 
check the nose-bleeding of children and of plethoric people. 
Cocaine may be used locally. Digitalis controls epistaxis, haem- 
optysis, and menorrhagia. A hot foot-bath, with or without 
mustard, is efficient. Spinal hot-water bag to the cervical and 
and upper dorsal vertebrae is serviceable (Ringer). 

PRESCRIPTIONS FOR EPISTAXIS. 

R Pulv. aluminis 

Pulv. acidi tannici aa 5j. — M. 

Sig. : To be insufflated into the nares anteriorly and posteriorly. 

— Sajous. 

R Extracti geranii mac. fluidi §j. 

Aquae giij. — M. 

Sig. : Syringe the nostrils, or plug with cotton saturated with the 
fluid. — Shoemaker. 

R Anti pyrin ^ij . 

In capsules no. xxiv. div. 

Sig,.: One, two or three to be taken as required. To be used 

with local treatment. — Robinson. 

ERYSIPELAS. 

Is a self- limited febrile affection, characterized by a local 
inflammation of the skin, and accompanied by constitutional 
symptoms. It is contagious (Bartholow). 

Causes. — The streptococcus erysipelatis is regarded as its 
specific cause. It prevails in hospitals and epidemics follow in 
the paths of armies. There are two kinds: idiopathic and trau- 
matic. It is a disease, of all ages, and occurs at all seasons. An 
abrasion of the surface or wound is the usual starting point. 

Symptoms. — The initial symptom is a chill. Headache 
comes on with the fever; and there are nausea, bilious vomiting, 
and entire loss of appetite. A sense of heat and tension is felt 
in the skin, which becomes red, cedematous and shiny. The red 
color disappears on pressure. The inflammation readies its 
highest point on the second or third day, and on the fourth, -fifth 
or sixth day the redness is fading. Desquamation of the skin 
takes place. The margin of the redness is not sharply defined, 



182 A COMPENDIUM OF PRACTICAL MEDICINE. 

but the swelling forms an abrupt ridge (Bartholow). Trauma- 
tic erysipelas begins as a bright red blush about the point of 
injury. Idiopathic erysipelas is most commonly facial, starting 
from either the nose, eyelid or ear (Loomis). 

Differential Diagnosis. — Erysipelas may be confounded with 
erythema and urticaria. Erythema is a superficial redness with- 
out inflammation — without heat and swelling — is without fever, 
and does not desquamate. Urticaria occurs in the form of 
wheals that itch a good deal and disappear in a few hours 
(Bartholow). 

Treatment. — In the more severe cases quinine combined with 
belladonna is good treatment. 

R Quininse sulphatis gr. xL. 

Extraeti belladonna? gr. iij. — M. 

Ft. pil. no. x. 
Sig. : One pill every four hours. 

Tincture of the chloride of iron, in half- drachm doses every 
four hours, is much commended. Milk, eggs, animal broths, and 
when necessary stimulants should be given. The bowels and 
kidneys should be kept active. 

Local Applications. — As a rule, irritating applications do more 
harm than good. Bartholow has seen mercurial ointment diluted 
ten times with lard very successful ; or vaseline Sj, acid carbolic 
5ss, or less, which should be brushed over the inflamed area three 
or four times a day. 

PRESCRIPTIONS FOR ERYSIPELAS. 

R Tincturse ferri chloridi 

Syrupi simplicis — aa gj. 

Aquae §ij . — M. 

Sig. : A teaspoonful well diluted every two or three hours. 

— Charity Hospital. 

R Plumbi acetatis 3J. 

Tincture opii 3j. 

Aqua; ad 0. j. — M. 

Sig. : Shake the bottle well, and wet cloths with the lotion and 
apply to the affected parts. — Charity Hospital. 

R Acetanilidi 3 j . 

Ft. in no. xv. capsules. 
Sig. : Two capsules as required for fever. — Osier. 



ERYTHEMA ECLAMPSIA. 183 

ERYTHEMA. 

By this term is meant simple, superficial inflammation of the 
corinm, the most trifling of all inflammations of the skin, and 
under it we must include roseola, strophulus and pityriasis. 

Symptoms. — There is no fever. The local symptoms are not 
severe. There is no distinct abrupt line of demarcation between 
the healthy and diseased skin. It does not usually spread 
rapidly. The itching is moderate. The color of the eruption is 
usually pink. The causes are very various. 

Erythema capitis or pityriasis is usually a very chronic 
affection and attacks the scalp and hairy parts of the head. 
Chilblain is a form of erythema which occurs in cold weather, 
and attacks the fingers, toes, ears, nose and cheeks. 

PRESCRIPTIONS FOR ERYTHEMA. 

R Zinci acetatis gr. ij. 

Aquae rosae 5j. 

Ungt. aquae rosae gj. — M. 

Sig. : Apply locally. — Fox. 

B Pulveris camphorae 5ss-j. 

Spiritus vini rectificati 5j • 

Sodii boratis gr. xl. 

Aquae rosae Sviij. — M. 

Ft. lotio. 
Sig. : Apply locally several times daily. — Tilbury Fox. 

R Pulveris camphorae 5ss-j. 

Zinci oxidi oiv. 

Pulveris amyli oj ■ — M. 

Sig.: Dust on lightly and do not allow to cake upon the skin. 

— Bulkley. 

ECLAMPSIA. 

Is the term applied to convulsions, tonic and clonic in char- 
acter, the foundation of which is laid in processes connected with 
pregnancy, labor, and childbed. It occurs once in about five 
hundred pregnancies. The attack resembles that of epilepsy, 
the cry only lacking (Lusk). 



184 A COMPENDIUM OF PRACTICAL MEDICINE. 

Terminations. — In favorable cases, after the expulsion of the 
ovuni, the attacks cease or diminish in frequency and intensity. 

Prognosis. — Is always serious. The earlier the convulsions 
occur in labor the more unfavorable the prognosis (Lusk). 

Treatment. — The urine of pregnant women should be exam- 
ined occasionally. If convulsions threaten, the nervous irrita- 
bility should be held in check by rectal injections of chloral and 
bromide of potassium (thirty grains each). From one -sixth to 
one-fourth of a grain of morphia should be injected hypodermi- 
cally. The lower bowel should be cleaned out by an enema, 
and a cathartic should be given by the mouth (Lusk). 

EMBOLISM. 

An embolus is any solid body floating in the blood current. 
Embolism is the occluding of a vessel by an embolus. Arteri- 
oles and capillaries are the usual seats of embolism. In general 
an embolus is part or all of a dislodged thrombus. 

Causes. — A slowing of the blood current, or a change in the 
walls of the vessels, a weak vis-a-tergo, vegetations on the valves 
of the heart, a foreign body introduced into a vessel, or a frac- 
ture, may cause embolism (Bartholow). 

Symptoms. — Embolic obstruction of a member is announced 
by a sudden and often intense pain and a chill, with numbness, 
loss or diminution of tactile sense, coldness, pallor of the skin, 
and a feeling of deadness and weight, and paralysis of the muscles 
(Bartholow). 

Treatment. — Ten grains of the carbonate of ammonia may be 
administered in a tablespoonful of the solution of the acetate, 
three or four times each day. Another remedy is the phosphate 
of soda, in drachm doses, three times daily for many weeks 
(Bartholow). 

ENURESIS. 

Called, also, incontinence of urine, is a common and trouble- 
some infirmity of children. It occurs both in boys and girls, but 
is more common in the former. In many children it dates back 
to infancy, but in others it begins at six or seven years. There 



ENURESIS. 185 

is an increase in the circular muscular fibres at the urethral ori- 
fice which constitutes the sphincter vesicae, an unstriped muscle 
and not under the control of the will. A second sphincter which 
aids materially in the retention of the urine is formed by the 
compressor urethrse, surrounds the whole membranous portion, 
and is a striped muscle and therefore controlled by the will 
(Smith). 

Causes. — In all cases the urine should be examined. The 
chief causes are: 1. Too great acidity of the urine, which will 
irritate and cause the bladder to contract. 2. Increased quantity 
of urine. This occurs from the free use of water or milk, or renal 
disease. 3. A vesical calculus. This will cause pain in passing 
water. Sound for stone. 4. Excessive irritability of the muscu- 
lar fibres of the bladder. This is the most frequent cause of 
enuresis in children. Belladonna relieves this condition. 5. 
Weakness of the muscular fibres which constitute the sphincter. 
This occurs in run down conditions. 6. Reflex action. This 
may be from phimosis, stricture of the urethra, irritation of as- 
carides, fissure of the anus, onanism, or vulvitis. 7. A psychical 
cause to which Bartholow alludes. The patient dreams that he 
is in a convenient place to pass water. 8. Malformation of the 
bladder. These are various (Smith). 

Prognosis. — Depends on the cause or causes. 

Treatment. — For the excessive acidity of the urine, three to 
iive drops of the liquor potassse should be given three or four 
times daily in a wineglassful of water. In belladonna we jdos- 
sess an agent which diminishes the functional activity, or inherent 
irritability of the bladder when the latter is in excess. Five 
drops of the tincture may be given every evening, to a child of 
five years, and the dose increased by one drop every second day. 
If the enuresis be due to an abnormally large secretion of urine, 
the liquid ingesta in the latter part of the day should be re- 
stricted. If it be due to diabetes, or chronic nephritis, treat 
these conditions. If it be due to a vesical calculus, lithotomy is 
indicated. If the cause of the enuresis be due to irritation in 
contiguous parts, as the rectum, penis or vulva, treat these con- 
ditions. If the cause be due to atony of the sphincter, mix 
vomica and ergot are indicated. 



186 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR ENURESIS. 

R Tinturse belladonnse Sj. 

Sig. : Ten to twenty drops thrice daily. — Ringer. 

R Acidi benzoici 5ij. 

Aquae cinnamomi g vj . — M. 

Sig. : A tablespoonful thrice daily. — Hartshorne. 

R Tincturse ferri muriatis sj. 

Decocti uvse ursse Syj. — M. 

Sig. : A tablespoonful two or three times daily. — Hillis. 

R Santonini gr. xyj. 

Olei ricini Sj • — M. 

Sig. : One or two teaspoonfuls before breakfast for two or three 

mornings. — Ringer. 

R Collodii Sss. 

Sig.: Put a drop in the meatus to seal it at bed time. Remove 
with finger-nail in morning. — Corrigan. 

R Chloral hydratis 3j. 

Syrupi tolutani Siiss. — M. 

Sig.: A teaspoonful thrice daily. (For infantile incontinence). 

— DaCosta. 

R Atropinse sulphatis gr. j. 

Aquae destillatae Sj . — M. 

Sig.: Four to eight drops in water. (For children). — Bartholow. 

ENDOMETRITIS. 

Is an inflammation of the endometrium. It is acute and 
chronic. The acute is a rare disease. The chronic is a frequent 
disease. 

Causes of the Acute. — This form occurs in young girls after 
acute fevers, or it may be due to taking cold during menstrua- 
tion, or to an extension of inflammation from other parts, to 
chronic catarrh, or laceration of the cervix. 

Symptoms. — Leucorrhcea. The discharge is thick, and often 
profuse, and resembles the white of an egg. Menorrhagia may 
be present. There is a sense of fullness or pain in the pelvis 
and loins. 

Treatment. — Treat the cause. Warm mucilaginous injec- 
tions, salines and rest will give the best results. 



EPIDIDYMITIS. 187 

The chronic form is divided into corporeal and cervical. 

Causes. — It may follow the acute disease, or start as a chronic 
affection from specific or other constitutional causes. It may be 
due to lacerated cervix, violence during coitus, ill-fitting pessa- 
ries, etc. 

Symptoms. — Leucorrhcea is the principal symptom. 

Treatment. — Treat the cause. If from lacerated cervix, 
reduce the size of the uterus by leeches, scarifications, iodine, 
hot-water injections and glycerine tampons. If the leucorrhcea 
still persists operate for laceration of the cervix. If there is 
eversion of the cervical mucous membrane scarify it. If there be 
chronic catarrh of the cervix, relieve the congestion by local 
measures, and use astringent applications to the cervical mucous 
membrane. If the body of the uterus is involved, the patient is 
usually sterile. In this case dilate the uterus with tents left in 
for twenty -four hours. After dilatation wash the cavity with 
carbolic acid water (40 per cent.) and apply to the endometrium 
by means of cotton on an applicator, solutions of corrosive subli- 
mate, zinc sulphate, or Monsel's solution and glycerine, repeating 
the application every three or four days. There should be 
absence from sexual intercourse (Pozzi, Skene and Grooddell.) 

EPIDIDYMITIS. 

Is an inflammation of the epididymis. It is the most 
common of all the diseases of the testicle. It occurs at all ages. 
One attack predisposes to another. It is often double. Fournier 
states that epididymitis occurs once for every eight or nine cases 
of gonorrhoea. In some individuals every attack of gonorrhoea 
is attended by a swollen testicle (Keyes). 

Causes. — Traumatic violence and cold may cause it. Pro- 
longed sexual excitement may cause it; but urethral inflamma- 
tion or irritation from gonorrhoea, stricture, or the passage of in- 
struments is by far the most active cause. It is an extension of 
the inflammation from the orifice of the ejaculatory duct to the 
epididymis. 

Symptoms. — First attacks, like first attacks of gonorrhoea, 
are usually the most severe. If there be a gleety or gonorrhoea] 



188 A COMPENDIUM OF PRACTICAL MEDICINE. 

discharge, it stops after the testicle begins to swell, but soon re- 
turns. There is a feeling as if the cord were being pulled upon, 
and pain in the back. There is frequent desire to urinate, and 
intense pain in the testicle, which is swollen. The pain is of the 
sickening variety, making patients feel faint. Rest on the back 
with the testicle raised modifies the pain. Epididymitis lasts 
about two weeks. Hardness of the epididymus may remain be- 
hind for months or even years. Sterility may be produced if the 
epididymitis be double. The testicles do not atrophy. The pa- 
tient is by no means impotent. He ejaculates semen, but it 
contains no spermatozoa. 

Treatment. — A suspensory bandage shonld be worn during 
the existence of urethral disease. Rest on the back, elevation of 
the testicle, hot flax-seed poultice, and a laxative, maybe all that 
is necessary. In severe cases, the testicle is enveloped from the 
start in a tobacco poultice. The poultice is made by mixing a 
paper of any fine -cut tobacco (Bj.) in about (3x.) of hot water, 
bringing the whole to a boil, and then adding ground flax seed 
until the proper consistence. The poultice is sprinkled with 
laudanum and placed upon the testicle as hot as can be borne, 
and covered with oiled silk. This poultice should be renewed 
every eight hours, until the indurated epididymus has lost its 
sensitiveness to pressure. Powdered opium (gi-ii.) mixed with 
stramonium ointment (§i.) may be used instead of the tobacco 
poultice. According to Keyes, the tobacco poultice is more ser- 
viceable than any other agent. Ice is not good. In extreme 
pain, when the cord has become strangulated, ten to fifteen 
leeches above the groin will often calm the pain as by magic. 
When pain is caused by extreme distention of the tunica vagin- 
alis with fluid, puncture it, and let out the fluid. Patients 
should stay in bed about one week in mild cases, and ten to 
twelve days in worst cases. Tonics and cod-liver oil do good 
(Keyes). 



EPISPADIAS EPITHELIOMA ERUCTATIONS. 189 

EPISPADIAS. 

Is a fissure of the superior wall of the urethra, with ectopia 
of the canal. It is very rare. The urethral opening may be 
upon the glans, or anywhere along the top of the penis, as far 
back as its root. When the membranous and prostatic urethra 
are involved, there is also exstrophy of the bladder. Epispadias 
is an arrest of development in the upper wall of the urethra. 

Treatment. — A cure cannot be promised from operative pro- 
cedure. Operations which have been undertaken very often fail, 
erections and contact of urine, with smallness of flaps, being the 
chief causes. A proper urinal is the best treatment. 

EPITHELIOMA. 

Is a form of cutaneous cancer. These tumors affect the 
skin or mucous membrane, and never originate in any other 
tissue. They infiltrate the parts with which they come in con- 
tact, and do not, as innocent tumors, simply separate them. They 
are the common forms of cancer found in the lips, tongue, 
oesophagus, rectum, scrotum, penis, clitoris, os uteri, vulva, etc. 
As a local disease, epithelioma may progress slowly for years, 
and cause little pain, and five^ six, or even fifteen years may 
elapse before advice is sought. The surface of an epithelial 
cancer may be dry and warty, or ulcerating; when ulcerating 
the discharge will be a thin or creamy fluid (Bryant). 

Treatment. — These cancers should always be removed; and 
the sooner this is accomplished, the better the prospects of a 
cure. 

ERUCTATIONS. (Offensive). 

Patients are sometimes greatly annoyed by eructations of an 
offensive gas, with the odor and flavor of rotten eggs — a gas 
consisting largely of sulphurretted hydrogen. In such cases the 
urine is loaded with oxalic acid, and to correct the oxaluria on 
which the eructations depend, the mineral acids should be given 
in the proper doses (Ringer). 



190 A COMPENDIUM OF PRACTICAL MEDICINE. 

ENTERALGIA. (See Colic.) 
EPHIDROSIS. 

Called also hyperidrosis, is an augmented sudoriparous 
secretion. 

Causes. — It may accompany any disease, and especially 
phthisis, as the result of debility. It may occur from excitement 
of the body or mind. In some cases there is no apparent cause. 
The perspiration may be general or local. It is sometimes lim- 
ited to one side of the body or face, when it is supposed to result 
from faulty innervation of the sympathetic. The sweating is 
often limited to the soles, palms, axillae, groins and genital 
organs. The hands are moist, clammy and cold from rapid 
evaporation of the sweat. In the feet, the secretion is confined 
by the stockings and shoes, and is apt to inflame the soles, leav- 
ing them very tender, so that walking or standing is painful. A 
species of bacteria which grows and multiplies in this sweat is 
the source of the offensive odor (Anderson). 

Treatment. — For the general sweating from wasting diseases, 
tonics, such as quinine, the mineral acids, strychnia and arsenic 
are recommended. Atropia in doses of yio gr. is the most power- 
ful of all remedies for general sweating. Some benefit may come 
from sponging the body with vinegar and cold water. For the 
local sweating, Dr. Thin advises the changing of the stockings 
twice daily. Dr. Marten advises washing the feet night and 
morning with soap and water, and sponging with the following 
lotion : 

R Plumbi acetatis 3j 

Aceti destillati §j. 

Spiritus vini methylati 3ij. 

Aquae ad ^xvj . — M. 

Dr. Simonton recommends the use of finely pulverized alum. 
The feet and socks are thoroughly dusted with the powder. 
Repeat this process every two or three days, and the feet will 
become hardened. In mild forms, tannic acid 5j. to ovj. of alco- 
hol may be rubbed on several times daily. Dust the feet thor- 
oughly with pulverized salicylic acid before putting on the 



FETOR OF AXILLA FEVERS. 191 

stockings, and wash them with permanganate of potassium 
(gr. xxx.-Oj.) evening and morning and apply belladonna lin- 
iment before going to bed to the feet. 

FETOR OF AXILLA, BREATH AND FEET. 

These are very annoying conditions and the physician is 
often consulted concerning them. Permanganate of potassium 
is an elegant toilet preparation for destroying the odor of a foul 
breath, the smell of the axillae, and the fetor of the sweat of 
the feet, and may be used as follows: 

R Potassii permanganatis gr. x.-xxx. 

Aquae £ viij . — M. 

Sig. : Apply locally frequently. — Bartholow. 

The following formulae may be used for the above condi- 
tions : 

R Sodii bicarbonatis 3iij. 

Aquae ^viij . — M. 

Sig.: Apply as a lotion frequently. — Bartholow. 

R Atropiae sulphatis gr. iv.-viij . 

Aquae rosae gij . — M. 

Sig.: Apply to the part with a brush. — Bartholow. 

R Acidi salicylici gr. xLv. 

Pulv. amyli 3V. 

Pulv. talc 3xxij. — M. 

Sig. : Dust over feet. 

JSr Sodii biboratis gr. xv. 

Thymoli gr. viiss. 

Aquae destillatae Sxij . — M. 

Ft. sol. 
Sig.: A mouth wash. (For letor of breath). — Magitot. 

FEVERS. (Classification of.) 

Fevers are distinguished as essential and symptomatic. A 
symptomatic fever is one which is secondary to some local affec- 
tion, such as an acute inflammation. 

An essential fever is one which is not secondary or symp- 
tomatic, but is primary or idiopathic. 

The essential fevers are as follows : 



192 A COMPENDIUM OF PRACTICAL MEDICINE. 

I. Febricula, a form of fever characterized by its short 
duration and mildness. 

II. Continued Fevers, which are distinguished by the un- 
broken continuity of the febrile phenomena, such as typhoid, 
typhus, relapsing and erysipelatous fevers. 

III. Periodical Fevers, which are distinguished by the 
occurrence of distinct paroxysms of the febrile phenomena, such 
as intermittent, remittent, typho- malarial and yellow fevers and 
dengue. 

IV. Eruptive', or exanthematous fevers, in which an erup- 
tion on the surface of the body is a prominent feature, as in 
small-pox, scarlet fever, measles, roseola and typhus. 

When the decline of a fever is rapid, occupying only a few 
hours, or a day or two, the fever is said to terminate by crisis. 
When the decline is protracted the termination is by lysis. (Each 
of the above fevers will be considered in its proper place.) 

Causes of Essential Fevers. — Micro-organisms are among the 
most important of fever -exciting agents, and are probably in- 
volved in the causation of all the essential fevers. Animal heat 
is the result of chemical processes, especially processes of oxida- 
tion, which are constantly going on within the body; but it is 
not known in what way the abnormal elevation of temperature 
is produced in fever (Flint). 

FISSURE OF THE ANUS. 

Produces more misery than any other local disease, and 
renders the natural act of defecation an agonizing one. 

Causes. — It is usually caused by the mechanical splitting of 
the orifice of the anus, from the passage of a large or indurated 
motion. It may be due to scratching the parts when highly 
irritable. Constipation, high feeding, sedentary habits, and want 
of local cleanliness are the common causes. 

Symptoms. — There is pain during \he passage of the motion. 
The motion may be streaked with a line of pus or blood. There 
is an unnatural contraction of the sphincter, and great pain is 
caused by attempting to introduce the finger. A careful exam- 
ination will often reveal the presence of an ulcer on the verge of 



FISSURE OF ANUS. 193 

or within the sphincter. Simple fissures are often associated 
with piles (Bryant). 

Treatment. — Happily for patients, the treatment of the dis- 
ease is as successful as it is simple. Simple fissures are readily 
treated by the administration of a laxative, the local application 
of nitrate of silver, or of lead lotion mixed with the extract of 
opium, and local cleanliness. 

When the parts are indolent, black wash may be used, or 
calomel dusted over the part. 

When an ulcer has existed for some time and has a hard 
base, the most efficient means of cure is division of the base of 
the ulcer with the superficial fibres of the sphincter, or forcible 
dilatation of the sphincter, and its laceration with the thumbs in 
the rectum. 

After=Treattnent, — The bowels must be kept slightly loose, 
and for this purpose the following may be used: 

{fc Olei olivse §j. 

Potassii carbonatis gr. xLv. 

Aquas Mentha? piperita? Sviij. — M. 

Sig. : One ounce three times daily. 

PRESCRIPTIONS FOR FISSURE OF ANUS. 

jfc Iodoformi , 

Acidi tannici aa 5j • — M. 

Sig. : Unfold or open the fissure, and fill with and dust over the 
powder. — -Bartholow. 

j& Potassii bromidi. 5iss. 

Glycerinse Sj. — M. 

Sig. : Apply with a brush locally. — Ringer. 

|& Acidi tannici.. 3j. 

Gly cerinse 5 ij . — M. 

Sig.: Introduce into the rectum night and morning on a tent. 

— Waring. 

J& Extracti hydrastis fluidi Sj 

Sig. : Apply to the fissure. — Bartholow. 



194 A COMPENDIUM OF PRACTICAL MEDICINE. 

FISSURES OF THE NIPPLE, 

Are excruciatingly painful, and are capable of exciting even a 
high degree of fever. They occur with greatest frequency in 
nipples which have been flattened by the pressure of corsets 
,(Lusk). 

Treatment. — The nipple should be kept clean, and all irri- 
tating matter removed. When one nipple only is affected, the 
child need only be applied to the sound side. The healing pro- 
cess may be promoted by lead-lotions, by a solution of tannin, 
or by some astringent ointment. Keep upon the nipple a rag 
wetted with Goulard's extract, a teaspoonful to a tumbler of 
water. If the child be troubled with sprue, its mouth and the 
nipples of the mother must be washed with a solution of 
boracic acid. 

PRESCRIPTIONS FOR FISSURE OF THE NIPPLES. 

|fc Cocaini muriatis gr. x. 

Aquae destillatae 5ij. — M. 

Sig. : Apply with a brush to the fissure half an hour before 
nursing, and wash well with warm water just before nursing. 

— L. Starr. 

Jfc Plumbi nitratis gr. iv-x. 

Glycerinae §j . — M. 

Sig.: Apply after nursing, and wash the nipple carefully before 
the next nursing. — Bartholow. 

Jfc Acidi carbolici gr. xxiv. 

Aquse Sj • — M. 

Ft. lotio. 
Sig.: Apply several times daily to the nipples. — Parvin. 

Jfc Acidi boracici gr. xx. 

Mucilag. acacise Sj- — M. 

Sig.: Use a nipple shield, and, after nursing, dry the nipple well 
with absorbent cotton and apply the lotion with a camel's hair brush. 
Should this fail, touch the fissure with a point of nitrate silver every 
other day. —Starr. 

Jfc Tincturse benzoini composita3 §ss. 

Glycerini 3ss. — M. 

Sig.: Apply to affected parts. — Stille. 



fistula. 195 

FISTULA. 

Is an unnatural communication between a normal cavity or 
canal and the outside of the body or with a second body or canal. 
According to their situation, they are named vesico- vaginal, and 
recto -vaginal in women, and recto -vesical in men, gastric, biliary, 
fgecal, anal, salivary and urinary fistulse. 

Causes. — They may be congenital or acquired. The acquired 
fistulge are either due primarily to some suppurative or ulcerative 
process or to mechanical violence, operative or otherwise, and 
subsequently to a want of repair. The fistula may be a short or 
a long narrow tract. When the fistula is of recent origin, the 
walls will be soft; when old, hard (Bryant). 

Treatment. — In a general way, it may be asserted that so 
long as the cause of a fistula exists repair cannot go on; so that 
in urinary fistula, when stricture is the cause, the stricture must 
be treated before the fistula. When the cause of the fistula has 
been cured or removed, then the fistula itself may be treated, 
and various are the means that can be employed for the same. 
Vaginal and rectal fistulse usually require plastic operations. 
The whole margin of the fistula must be pared with nicety and 
accuracy, and the raw surfaces brought into apposition. The 
constitutional treatment resolves itself into tonics, good food and 
fresh air. 

PRESCRIPTIONS FOR FISTULA. 

j& Cupri sulphatis gr. ii.-iv. 

Aquae §iv. — M. 

Sig. : Inject once a day. — Sir A. Cooper. 

|& Argenti nitratis gr. ij. 

Aquas destillatae gviij . — M. 

Sig.: Inject once a day. (Fistula in ano.) — Druitt. 

{fc Tincturse iodini 3J. 

Sig.: Inject once daily. — Waring. 

Jfc Extraoti sanguinaria) fluidi sij. 

Sig.: Inject a sufficient quantity to fill and distend the fistula. 

—Phillips. 



196 A COMPENDIUM OF PRACTICAL MEDICINE. 

FLATULENCE. 

Trie gas in the intestinal canal may be merely air which is 
swallowed; or it may result from fermentation or decomposition 
of food. It causes a disgust for eating, a feeling of distention, 
and sometimes actual pain, shortened breathing, palpitation of 
the heart, eructation or belching of gas with or without an odor 
(DaCosta). 

Treatment. — According to Wood, the remedy most effective 
to remove and permanently cure a disposition to the accumula- 
tion of flatus in the bowels is an infusion made with half an 
ounce of calumba, half an ounce of ginger, a drachm of senna, 
and a pint of boiling water, and given in the dose of a wine- 
glassful three times a day. 

PRESCRIPTIONS FOR FLATULENCE. 

|& Aquae camphorae §iij. 

Tincturae lavandulae comp §j. — M. 

Sig.: A tablespoonful every hour or two. (For hysterical flatu- 
lence and flatulent colic occurring at climacteric.) — Bartholow. 

jfc Spiritus chloroformi 

Tincturae cardamonii comp...aa...gij. 
Sig.: A teaspoonful every half hour in water. — Bartholow. 

Jfc Misturae asafoetidae |iij. 

Sig. : A teaspoonful when necessary. (For the flatulent colic of 
infants.) — Bartholow. 

Jfc Spiritus aetheris compositi ^ij. 

Aquae camphorae gij. — M. 

Sig.: Two teaspoonfuls to expel flatus from stomach. 

— Bartholow. 

Jfc Spiritus aetheris comp 

Tincturae ammonii valerian... aa...£J. — M. 
Sig : A teaspoonful in water every fifteen minutes until re- 
lieved. (For hysterical flatulence and globus hystericus.) 

— Bartholow. 

J£r Olei terebinthinae 3j. 

Sig.: Three to five drops on a lump of sugar. — Bartholow. 



FKECKLES. 197 

FRECKLES. 

Called also lentigo, is the most circumscribed form of pig- 
mentation, and the deformity to which in well marked cases it 
gives rise, is so well known as to require no description. It is 
most apt to appear in persons with delicate skins, and in those 
who have fair complexions, but above all in red-haired people. 
It is always aggravated by exposure to the sun, hence it is met 
with on the face, neck and hands more particularly, and is most 
pronounced during the summer months. 

Treatment. — Avoid unnecessary exposure to the sun. Ac- 
cording to Bartholow the following lotion is useful in freckles, 
sunburn and tan : 

JSr Potassii carbonatis giij . 

Sodii chloridi gij. 

Aquse rosse ^ viij . 

Aquae aurantii flor gij. — M. 

Sig. : Apply to part. 

jfc Liquoris potassse 3j\ 

Aquse rosse §ij. — M. 

Ft. lotio. 
Sig.: Face-wash. (In tan and freckles.) — Todd. 

(fc Hydrargyri chloridi corr gr. j. 

Zinci oxidi gij . 

Zinci carbonatis ,...5ss. 

Glycerinse ^ij. 

Aquse rosse j§ viij . — M. 

Ft. lotio. 
Sig.: Apply with a sponge. (In freckles and sunburn). — Fox. 

j& Lactis recent^ gxiiss. 

Glycerinse ^viiss. 

Acidi hydrochlorici ZH.Lxxv 

Ammonii muriatis 3j. — M. 

Ft. lotio. 
Sig.: Apply morning and evening with camel's hair brush. 
(In tan and freckles). — Monin. 



198 A COMPENDIUM OF PRACTICAL MEDICINE. 

FROST=BITE. 

When concentrated cold is applied for a period sufficient to 
arrest the circulation in a part, a frost-bite is the result. The 
first effect of cold upon a part is a sense of numbness and weight 
and a feeling of tingling. If the cold continue, the part will 
become stiff and at last insensible, feeling dead. The frozen 
part is white and waxy. The constitutional effects of cold are 
at first stimulating, and subsequently depressing. 

Treatment. — Sudden alteration of temperature is most in- 
jurious. The aim of the surgeon should be to recall the 
affected parts gradually to their normal condition by gentle 
friction in the course of the veins with furs or flannels. Stimu- 
lants should be administered internally. Friction with snow or 
ice-water is most useful. On reaction the parts may be raised, 
and warm milk with a little brandy given. Should reaction be 
too severe, it must be checked by lead or spirit lotions. 

When gangrene follows, carbolic acid and oil are probably 
the best applications. 

If a whole foot be frozen, amputation may be called for, the 
surgeon always waiting until the line of demarcation is formed. 

PRESCRIPTIONS FOR FROST=BITE. 

R Acidi carbolici gj. 

Tinct. iodinii ^ij . 

Acidi tanici 3ij . 

Cerati simplicis %iv. — M. 

Ft. ungt. 
Sig.: Apply locally. — Bartholow. 

R Linimenti camphorse 

Linimenti saponis comp 

Olei cajuputi aa §j. — M. 

Ft. linimentum. 
Sig.: Apply to the unbroken skin. —Brande. 

B Camphoraa 3J . 

Olei cajuput 3ij. 

vEtheris gj. — M. 

Ft. linimentum. 
Sig.: Apply locally to the unbroken skin. — Tortual. 



FUEUXCLE — FITS FELON FAIXTIXG. 199 

FURUNCLE. (See Boil.) 

FALLING SICKNESS. (See Epilepsy.) 

FITS. (See Convulsions.) 

FLOODING. (See Menorrhagia.) 

FELON. 

Called also paronychia, or whitlow, is an abscess of the 
thumb or fingers. The superficial whitlow or felon consists of 
inflammation of the surface of the skin of the last phalanx. It 
is generally seated immediately around and beneath the nail. It 
is attended with great pain and throbbing, and suppuration at 
the root of the nail, which may come off. 

The deep-seated variety is attended with a severe throbbing 
pain, great tenderness, tense and resisting swelling, and great 
constitutional disturbance. The inflammation usually begins in 
or beneath the periosteum. It may lead to suppuration, and 
leave the fingers stiff and useless. 

Treatment. — If purgatives and fomentations do not speedily 
bring relief, the finger must be freely laid open. The knife 
should be carried deep enough to feel the resistance of the bone 
or tendon. A strong solution of nitrate of silver in nitric ether 
applied over the part may abort the affection, if at the beginning 
(Bartholow). 

FAINTINGS. 

Treatment. — In the threatened fainting, it is a good plan to 
direct the patient, whilst sitting down, to lean forward, and place 
the head between the legs as low down as possible, so that the 
blood may gravitate to the brain. Brandy or wine are the best 
remedies, when the heart is suddenly enfeebled from fright, loss 
of blood, accidents or other causes. Salts of ammonium, applied 
to the nose, and breathed into the air-passages, arc commonly 
used in fainting. Cold water smartly sprinkled on the face of a 
swooning person is a familiar way of restoring consciousness 
(Ringer). 



200 A COMPENDIUM OF PRACTICAL MEDICINE. 

FATIGUE. 

Treatment. — The sitz-bath greatly relieves fatigue and 
soothes an irritable, restless state of the nervous system. A 
pedestrian, after great exertion and fatigue, will find it an agree- 
able restorative, preventing stiffness and aching muscles, to strip 
and wrap himself in a dripping wet cold sheet, well rubbing 
himself afterwards; but if stiffness still remains, a few drops of 
tincture of arnica taken internally will remove it. Tea and 
coffee are especially useful in a fatigued state of the system, and 
under ordinary circumstances are preferable in this respect to 
alcoholic drinks (Ringer). 

FLUSHING HEATS. 

The distressing symptoms occurring during the "change 
of life " are very various. There are heats and flushings, 
followed by free perspiration, and prostration is sometimes 
extreme. These symptoms will generally give way to bro- 
mide of potassium. Eucalyptol is given in the various symp- 
toms connected with the change of life, as flatulence, palpitation 
and flushings. A woman, from the sudden arrest of menstrua- 
tion, or through depraved health, or nervous depression, or more 
frequently at the "change of life," suffers from frequent attacks 
of flushings or heats, starting from various parts, as the face, 
epigastrium, etc., and thence spreading over the greater part of 
the body. These heats may last a few minutes only, or an hour 
or more, and may be repeated many times a day. The least ex- 
ertion or excitement may bring on these heats, and such a 
patient generally complains of cold feet, and sometimes of cold 
hands. The flushings are occasionally abruptly limited, reach- 
ing to the thighs, knees or elbows, and while all the parts above 
these feel burning hot, the parts below feel icy cold. In many 
of these cases palpitation or flutterings at the heart occur on the 
slightest excitement. 

Nitrite of amyl will prevent or greatly lessen these flush- 
ings or heats, and should be given in doses of a tenth to a sixth 
of a minim, in thirty times its volume of rectified spirit, every 



FEACTUEES. 201 

three hours, with an additional dose as soon as the flush begins. 
Both men and women, but chiefly women about forty or fifty 
years of age, are apt to complain of a sensation of great weight 
and heat on the top of the head, with frequent flushings of the 
face, suffusion of the eyes, hot and cold perspirations, and some- 
times shooting pains passing up the back of the head In these 
cases, a drop of laudanum, with two of the tincture of nux 
vomica, repeated three or four times a day, will give great re- 
lief. Valerianate of zinc, given in three to five grain doses in a 
coated pill, will usually remove the flushings of the face, hot and 
cold perspirations, fluttering at the heart, and heat, and weight 
on top of the head (Ringer). 

FRACTURES. 

A fracture is a solution of continuity of bone, while dislo- 
cation is a solution of contiguity. 

Kinds, — 1. Complete. 2. Incomplete. 3. Epiphyseal sep- 
aration. A complete fracture is where division completely 
traverses the thickness of the bone. An incomplete fracture is 
where division does not completely traverse the thickness of the 
bone. The epiphyseal is where the epiphysis becomes separated 
from the bone or diaphesis. 

Complete fractures may be of the following kinds: 1. 
Simple. 2. Compound. 3. Comminuted. 4. Complicated. 5. 
Impacted. 6. Multiple. 7. Gunshot. 

1. Simple is where the bone is broken in one place only, 
and with no communication with the external air. 2. Compound 
is where there is communication with the external air. 3. Com- 
minuted is where there are a great many small pieces of bone. 
4. Complicated is where the fracture is associated with the main 
vessels, nerves, veins, or some internal organs. 5. Impacted is 
where compact tissue is driven into the cancellous tissue. 6. 
Multiple is where the bone is broken into several pieces. 7. 
Gunshot is where the fracture is the result of the explosion of 
fire-arms. Any fracture may be oblique, transverse, longitudinal 
or dentated. Incomplete fractures are the following: 1. Green- 
stick. 2. Partial. 3. Fissured. 4. Punctured. 5. Stellate. (>. 



202 A COMPENDIUM OF PRACTICAL MEDICINE. 

Spiral. 7. Gunshot. Epiphyseal separations occur in early life, 
under twenty years. The causes, symptoms and treatment are 
the same as fractures. Most fractures occur between the ages of 
twenty-five and sixty. More common in men than in women. 
More occur in winter than in summer. The clavicle and radius 
are more often broken than any other bones. 

Symptoms. — 1. False point of motion. 2. Eotary displace- 
ment. 3. Angular deviation from the normal axis. 4. Crepitus. 
5. Tenderness on pressure. 6. Unnatural mobility. 7. Retrac- 
tion of muscles. 8. Ecchymosis and swelling. 9. Shortening. 
Crepitus is the most important sign, but may be absent some- 
times, because of something between the fragments. 

General Management. — Give every fracture proper and dili- 
gent attention. When called to see a case: 1. Do not move the 
patient to a vehicle and do not set him upright. 2. Put on a 
temporary splint at once and carry home in a horizontal position. 
3. Put patient on a hard mattress and not on a feather bed. 4. 
Cut off the trousers, boot and shoe, and do not pull them off. 
5. Inspect the fracture, have a good assistant to make strong ex- 
tension of the limb in the long axis, and then he may raise the 
limb. You may then inspect it to a better advantage. 6. Make 
extension. Get the great toe in a line with the inner margin of 
the inner malleolus and patella and then have the foot at right 
angles with the limb. Give a hypodermic injection of morphine 
to relax muscles. You may divide every tendon in case you 
can not keep the muscles from contracting. 

Diagnosis. — Three signs are sure: 1. Mobility. 2. Crepitus. 
3. Displacement. In cases of doubt, give an anaesthetic. Treat 
any injury as you would a fracture when there is doubt as to 
what it is. (For the treatment of special fractures, see works 
on surgery.) 

GALACTORRHEA. 

Is a constant dribbling of milk from the nipple. It is an 
affection which may continue long after lactation has been sus- 
pended. It acts like any other profuse discharge in exhausting 
the strength and producing a wasting of the tissues. 



GALACTOEKHCEA GALL-STONES GAXGKEXE. 203 

Treatment. — Consists in interrupting lactation, in compres- 
sion of the breasts with bandages, and tonics to repair the gen- 
eral health. Of special measures, saline laxatives and the inter- 
nal administration of iodide of potassium are of most repute 
(Lusk). f 

PRESCRIPTIONS FOR GALACTORRHEA. 

|& Olei camphorati gvj. 

Sig. : Apply externally to breasts. — Waring. 

J& Potassii iodidi gj. 

Aquae §j. — M. 

Sig.: Twenty-five to thirty drops in water, once or twice daily. 

— Roussell. 

fy Atropinse sulphatis gr. iv. 

Aquae rosae gj . — M. 

Sig.: Apply on lint around the breasts, and remove when the 
throat becomes dry. — Bartholow. 

QALL=ST0NES. (See Biliary Calculi.) 
GANGRENE. 

Called also mortification, is the death of any part of the 
body in consequence of disease or injury. It is divided into 
acute and chronic. The acute is known as moist gangrene. The 
chronic, as dry or senile gangiene. 

Causes. — Predisposing and exciting. The predisposing 
causes are : Defective nervous power, as in palsied limbs, or 
division of large nerve trunks; general debility from poor food 
and improper nourishment; use of alcoholic drinks; atheroma- 
tous changes in the arteries of old people. The exciting causes 
are produced by whatever interferes with or arrests the circula- 
tion of a part. The arterial blood to a part may be cut off by 
accident, by ligature, by thrombosis or embolism of the arteries. 
The circulation through a part may be obstructed by the growth 
of a tumor or by the formation of bed-sores. Extreme weakness 
of the heart's action may produce gangrene, or whatever de- 
stroys the cells of a part, as injuries, chemical agents, prolonged 
use of mercury or excessive heat or cold (Bryant). 



204 A COMPENDIUM OF PRACTICAL MEDICINE. 

Symptoms. — Are local and constitutional. Locally, at the 
beginning, the pain and tenderness of the part become most 
acnte; it is of a severe, burning character; the discoloration is of 
a vivid-red color; the local heat is increased. The constitu- 
tional symptoms are of a low typhoid cast. There is a profuse 
perspiration. When the part is dead, the pain and tenderness 
cease; it becomes cold, the bright redness disappears, and large 
blisters form which burst and leave a greenish discoloration 
beneath. The limb becomes greatly swollen, soft and boggy; a 
sickening fetid smell is exhaled. When the progress of the dis- 
ease is arrested, the line of demarcation forms which separates 
the living from the dead tissue. 

Treatment. — To avert the threatened gangrene the patient, if 
young and robust, with a full hard pulse, should be purged. If 
there is a great deal of inflammation, incisions should be made 
into the part, and lead water with laudanum applied. The timely 
use of a blister over the entire surface will sometimes bring 
about healthy action, and set aside the tendency to gangrene. 
Iron, quinine, strychnine, stimulants and nutritious diet 
should be prescribed. The limb should be put in an aseptic 
condition by washing it with toVo solution of corrosive sublimate, 
and then applying cotton wool and a bandage. It should be 
elevated and at rest. To allay fetor, permanganate of potassium, 
carbolic acid and the chlorides must be resorted to. Cleanliness 
and thorough ventilation of the apartments must be insisted 
upon (Bryant). 

CHRONIC, DRY OR SENILE GANGRENE. 

Causes. — Diseased state of the arteries, weak heart and con- 
sequent feeble circulation may cause it. In many cases it begins 
without any apparent exciting cause. In old people, diabetes is 
a fertile cause of gangrene of th.t toes and feet. 

Symptoms. — There will be a sensation of weight in the part, 
with coldness, numbness, itching and tingling of the feet, and 
cramps of the calves are complained of. On examination, a 
small dark or purplish spot will be found on the inside of one of 
the toes, not larger than a mustard seed. This is followed by a 
vesicle which exposes a black surface on bursting. This grad- 



GANG-RENE. 205 

ually spreads until the whole foot is involved. It may begin on 
several toes at the same time, or it may show itself on the instep 
or heel. The part destroyed becomes black, dry, withered, cold 
and insensible. 

Treatment. — As soon as the line of demarcation forms be- 
tween the dead and living tissue, the health of the patient im- 
proves. Tonics with stimulants should be given early. Locally 
cotton wool in thick layers around the foot and limb must be 
used. 

Question of Amputation. — If the gangrene is the result of a 
severe injury, and it is rapidly spreading, or if it arises from a 
wound or ligature of an artery, the rule is to amputate at once. 
In the above cases, do not wait for the line of demarcation to 
form. 

In chronic gangrene, due to diabetes, or ergotism, wait for 
the line of demarcation to form. In cases of frost-bite, or burn, 
or disease of the arteries, wait for the line of demarcation 
(Bryant). 

PRESCRIPTIONS FOR GANGRENE. 

R Brorainii |j. 

Sig. : Apply to the slough with a glass rod. — Bartholow. 

R Cerati resinse comp 3J. 

Extracti opii aquos 3J. 

Olei olivte ^ij. — M. 

Ft. ungt. 
Sig. : Apply locally after the slough has separated. 

— Witherstine. 

R Liqour hydrogenii peroxidi §iv. 

Sig.: Apply locally, pure or diluted. 

R Acidi nitrici gjl 

Sig.: Apply to the ulcer with a glass rod until it is converted 
into a firm, dry mass. — Waring. 

R Sodii sulphitis gj-ij. 

Aquae Sx. — M. 

Ft. lotio. 
Sig. : Use as a lotion, or apply on compresses. — Waring. 

R Pulv. acidi salicylici 5J. 

Sig.: Use locally as a dusting powder. (To destroy fetor and 
change morbid action). — Bartholow. 



206 A COMPENDIUM OF PRACTICAL MEDICINE. 

GASTRALGIA. 

Is a painful state of the sensory nerves of the stomach, 
induced by irritation, and without fever. 

Causes. — The neurotic temperament, malaria, and the abuse 
of tea and coffee have no little influence in causing the disease 
(Bartholow). Strawberries, or honey, or other ingesta, or cold 
may bring on an attack (Flint). 

Symptoms. — Severe paroxysmal pain in the epigastrium, 
radiating upward over the chest and downward through the ab- 
domen, and through to the back is the most characteristic 
symptom. 

The pain is diminished by pressure, and the patient instinct- 
ively lies or presses firmly on the abdomen. In the severest 
cases the pain is excessive. The duration of the attacks may be 
a few hours, or a day or two, or a month with intermissions. 
Usually the attacks are of short duration, and terminate with 
eructations of gas and with vomiting. Persons of sedentary 
habits are more likely to be affected than those engaged in active 
pursuits (Bartholow). 

Treatment. — During a paroxysm, the first point is the relief 
of pain by the hypodermic injection of morphine. The pain 
and also the nausea and vomiting may be arrested by creosote or 
carbolic acid. Equal parts of tincture of iodine and carbolic 
acid, of which a drop may be given every hour in a little cold 
water, will often stop the pain and vomiting. 

The paroxysms may be relieved by one drop of Fowler's so- 
lution and two to five drops of tincture of opium. The long 
continued use of arsenic in a small dose — one drop ter in die of 
Fowler's solution — is more effective according to Bartholow's ex- 
perience than any remedy mentioned. 

Salicylic acid is sometimes serviceable for intermittent cases. 
When attacks of gastralgia are due to indigestible food, the first 
duty is to empty the stomach. Excellent results are often ob- 
tained from the use of muriatic acid, combined with tincture of 
mix vomica. The diet should be regulated. A sinapism and 
fomentations to the epigastrium are useful as aids. Mild cathar- 
tics may be given (Bartholow). Bismuth in doses from a scruple 



GASTRALGIA GASTRIC ULCER. 207 

to a drachm three or four times a day, has been found to be 
curative, according to Flint. The constant current in the hands 
of Leube, Beard, and Rockwell has proved efficacious. Change 
of habits from those of sedentary to active life is of the first 
importance. 

Alcoholic stimulants in moderation with meals may be ad- 
vised for a time (Flint). 

PRESCRIPTIONS FOR GASTRALGIA. 

R Tincturse conii 3j. 

Tincture Valerianae 

Tincturse opii camphoratse 

Aqua? lauro-carasi — aa gij . — M. 

Sig. : Seven drops in a little milk when the pain appears. 

— Monin. 
R Extracti cocae fluidi 3J. 

Syrupi aurantii flor 3v. 

Aquae ad ^ij. — M. 

Sig. : A teaspoonful every hour till relieved. — D'Ardenne. 

R Liq. chloroformi aq. sat £xv. 

Aquae aurantii flor 3xiv. 

Tincturae anisi stellati 3J. — M. 

Sig. : A teaspoonful every quarter of an hour. 

— Dujardin-Beaumetz. 

R Liquoris potassii arsenitis ^j. 

Sig. : One drop in water three times daily continued for months. 

— Bartholow. 

GASTRIC ULCER. 

Causes. — Ulcer of the stomach is a comparatively common 
disease, and is found to exist in five per cent, of the deaths from 
all causes. It occurs in females oftener than in males. The lia- 
bility to it is greatest between the ages of fourteen and thirty, 
although no age is exempt; it has been found in the new born 
babe and in the octogenarian. Amenorrhea, anaemia, chlorosis, 
the puerperal state, prolonged lactation, and tuberculosis are 
predisposing causes. Ulcer of the stomach may result from an 
habitual stooping position, as in milliners, seamstresses and shoe- 
makers. Burns of the chest and abdomen sometimes causes 
ulceration of the duodenum (Bartholow and Loomis). 

Symptoms. — It is a chronic malady usually. There are 
three important symptoms of gastric ulcer — pain, indigestion. 



208 A COMPENDIUM OF PRACTICAL MEDICINE. 

and vomiting (haematemesis). Pain is one of its constant symp- 
toms; at first it is dull and heavy, then it becomes burning, 
gnawing, and fixed, boring through from front to back, and 
occupying a space which the finger may cover. It usually comes 
on soon after the ingestion of food, and lasts during the entire 
period of stomach digestion; occasionally it is not present until 
an hour or so after eating. Very great tenderness is experienced 
on pressure over the vertebrae behind and the seat of pain in 
front. Attacks of gastralgia occasionally come on. Nausea and 
vomiting may accompany the pain; in some instances there is 
pyrosis, or "water -brash;" usually the vomiting occurs when 
the pain is most severe, and temporarily relieves the pain. The 
matter vomited consists, first of the food taken into the stomach, 
which has a strong acid reaction; later it is mingled with bile. 
Vomiting of blood is the most characteristic single symptom, but 
is not pathognomonic. It is absent in about one -third of the 
cases, and may occur only at the monthly period. Cachexia is a 
late symptom, the appetite is rarely impaired, sometimes it is 
even increased. The face, when the pain is intense, is "drawn" 
and haggard, which by some is regarded as characteristic of 
ulcer of the stomach. Obstinate constipation is the rule in ulcer 
of the stomach, but hemorrhage may cause diarrhoea. The blood 
gives to the dejections a dark color, and a tarry consistence 
(Bartholow and Loomis). 

Differential Diagnosis. — Gastric ulcer may be mistaken for 
cancer of the stomach, hepatic colic, cardialgia, or gastralgia, 
and chronic gastric catarrh. In cancer there is usually a history 
of hereditary cancer. Cancer is seldom met with in persons 
under forty; while ulcer of the stomach occurs most in young 
adults, and is usually associated with anaemia, chlorosis, pro- 
longed lactation, or compression of the stomach, as in cases of 
shoemakers and sewing- girls. The pain in cancer is continuous, 
and described as lancinating; while in ulcer the pain is inter- 
mittent, greatly increased by taking food, often referred to the 
lower dorsal vertebrae, and described as gnawing or burning. In 
cancer, haematemesis has a sooty or coffee -ground appearance, 
while in ulcer it is a bright red arterial blood. Vomiting, in 
cancer does not relieve the }3ain, is not very severe, and comes on 



GASTRIC ULCEE. 209 

late; but in ulcer it is severe, comes on early, and affords tem- 
porary relief from the pain. The cancerous cachexia and de- 
bility are present early and steadily progress in cancer; while in 
ulcer there may be pallor, but no characteristic cachexia. The 
presence of an epigastric tumor establishes the diagnosis of 
cancer. In hepatic colic, the pain is in the region of the gall- 
bladder, and shoots to the right shoulder and back, comes on 
suddenly and suddenly ceases. 

In cardialgia or gastralgia, the pain is not excited or in- 
creased by the introduction of food into the stomach, but often 
comes on when the stomach is empty, while in ulcer the pain is 
associated with ingestion of food. In cardialgia or gastralgia, 
pressure over the epigastrium, and the ingestion of food, relieve 
the pain; the reverse is the case in ulcer. Cardialgia or gastral- 
gia is relieved by the constant current and faradization, which 
increases the pain of gastric ulcer. In cardialgia there will be 
a history of neuralgia in other parts of the body. 

In chronic gastric catarrh with hemorrhage there is the his- 
tory of diseases of the liver, heart, lungs or kidneys; while in 
gastric ulcer there is usually no such history. The pain in gas- 
tritis is not so intense as in ulcer. A coated tongue, great thirst, 
malaise, and pyrexia are prominent in cases of chronic gastritis, 
and absent in ulcer. The vomiting in chronic gastritis conies 
on in the morning, and the matter vomited is stringy mucus; 
while in ulcer the attacks of vomiting usually follow the 
taking of food (Bartholow and Loomis). 

Prognosis. — Must be regarded as serious (Bartholow). 

Treatment. — Best the stomach by keeping the patient in bed, 
and restricting the diet to peptonized milk — a tablesj)oonful to a 
teacupful may be given every two hours during the day and 
night. Digested beef- juice may also be given. All vegetables, 
tea, coffee, starchy foods and fruits must be prohibited. If all 
kinds of food are rejected, rectal alimentation must be practiced, 
four ounces of defibrinized blood (containing four grains of 
chloral to prevent its decomposition) may be thrown into the 
rectum every six hoars (Loomis). Bartholow regards one to 
three drops of Fowler^ solution three times daily the most im- 
portant remedial agent. He also gives half -grain doses three 



210 A COMPENDIUM OF PRACTICAL MEDICINE. 

times a day of nitrate of silver. Fifteen grains three times daily 
of sub-nitrate of bismuth are effective. The flatulence may be 
mitigated by sulphite of soda, carbolic acid, or the alkalies. 
The constipation may be relieved by the saline mineral waters, 
or by castor -oil where the patient will bear it. After some im- 
provement has been made, rice, soft-boiled eggs, animal broths, 
stale bread and cocoa may be allowed. 

PRESCRIPTIONS FOR GASTRIC ULCER. 

R Creasoti XTIiv. 

Aquae §ij. — M. 

J3ig.: A tablespoonful three or four times daily. ■ — Niemeyer. 

R Liquoris potassii arsenitis ^ss. 

Sig.: One drop, repeated as required to relieve the pain and 
•vomiting. — Bartholow. 

R Skimmed milk two parts and liquor calcis one part, mixed 
as a steady diet. — DaCosta. 

R Bismuthi subnitratis gij. 

Pulv. opii. gr. iij. — M. 

In pulv. no. xii. div. 
Sig. : One powder thrice daily, followed continuously by the fol- 
lowing: 

R Argenti nitratis gr. v. 

Tincturse opii 3iss. 

Aquse anisi ad ^iiss. — M. 

Sig.: A teaspoonful thrice daily with rest to the stomach. 

— W. H. Thomson. 

GLANDS, (Enlarged Lymphatic.) 

Chronic glandular enlargement is a very common affection. 
It is found in the strumous and feeble child as a chronic and 
slightly painful enlargement of a gland or glands, more particu- 
larly those beneath the jaw and about the neck. 

At times these glands suppurate and leave ugly sores. 

Treatment. — For the ordinary or strumous enlargement of 
the glands in children there is no drug equal to cod-liver oil, the 
syrup of the phosphate-, or of the iodide of iron, or the tincture 
of quinine. Good food and fresh air are also essential points in 
the treatment of these cases (Bryant). 



ENLARGED GLANDS GLEET. 211 

PRESCRIPTIONS FOR ENLARGED GLANDS. 

R Potassii iodidi 3j.-iv. 

Syrupi aurantii cort • •...§■ 

Aquas cirmamom ii ad £iij . — M. 

Sig. : A teaspoonful in water three times daily. — Ringer. 

R Calcii sulphidi. gr. vj. 

In pil. no. xxiv. div. 
Sig.: One pill every four to six hours. — Ringer. 

R Syrupi ferri iodidi 3j. 

Sig.: Five to forty minims, according to age, well diluted, after 
meals. — Bartholow. 

R Ungt. plumbi iodidi gj. 

Sig.: Apply to gland. — Bartholow. 

R Ungt. iodi comp ^j. 

Sig.: Apply to gland. — H. B. Sands. 

GLEET. 

Is a ruueo- purulent discharge from the urethra, the chronic 
stage of gonorrhoea. In gleet, a certain amount of sticky bluish 
fluid, often only a drop at the meatus in the morning— continues 
to be secreted after gonorrhoea, from altered patches of the 
urethra, or coming from the congested membrane behind a 
stricture. Gleet, then, is a symptom of two structural lesions, 
and signifies that there are patches of congestion in the canal, 
covered or not by granulations, or that stricture exists, and that 
the discharge comes from behind it. Prostatic congestion and 
enlargement are also liable to be attended by a slight gleet. 

Gleet tends to last indefinitely, and an individual so affected 
is a ripe subject for bastard gonorrhoea. The sinrple congested 
patches which furnish the gleety discharge, are kept from getting 
well by alcohol, malt liquors, sexual excesses, fatigue, violent 
exercise, anaemia, gouty or strumous habit. Gleet is contagious 
when purulent, but only if it contains gonococci. All urethral 
discharges become gleety before they cease (Keyes). 

Treatment. — Eyerything earthly has an end, even a gleet, as 
Thiry has sagely remarked, and no treatment will succeed where 
over-treatment has only served to keep up the evil. As stricture 



212 A COMPENDIUM OF PRACTICAL MEDICINE. 

already present or forming is the most common of all causes for 
continued gleet, it should be sought for and treated. Where no 
lesion is discovered, the urine must be kept mildly alkaline,, 
sexual intercourse avoided, and copabia or oil of sandal -wood or 
cubebs may be given. Stimulating or astringent injections 
should be employed, such as follows : 

R Zinci chloridi gr. j. 

Aquae Sj.— M. 

R Cupri sulphatis., g r -j- 

Aqua? Sj . — M. 

R Ferri persulphatis 5ss. 

Aquse 5 vj . — M. 

Or, 

R Zinci sulphatis gr. i-ii] . 

Liquoris plumbi subacetatis..dil...5j. — M. 
Or, 

R Aluminis exust gr. x. 

Aquas Sj. — M. 

0r ' 

R Acicli tannici gr. v-x. 

Aquse ...Sj- — M. 

Or, 

R Zinci permanganatis gr. ss-ij. 

Aqua? Sj- — M. 

Or, 

R Hydrargyri chloridi corrosi gr. ss. 

Aquse gxij. — M. 

Alcohol is often efficient, and may be used as follows : To 
commence with two parts of rose water to one of red wine, and 
continue increasing the latter until pure wine can be used. 
Glycerine may be combined with any of the above formulae. 

Three points must be remembered in regard to injections : 
1. They must not be too strong. 2. They must be continued for 
at least ten days after the discharge ceases. 3. They may 
produce a hypersecretion of the urethral mucus, and thus keep 
up the discharge. Any injection, thrown too deeply into the 
canal, may light up epididymitis, or cystitis. 

Deep urethral injections may be used, if the discharge 
comes from the membranous urethra. Locate the granulating 
area with a bull), and there deposit three minims of a solution 



GLEET. 218 

of nitrate of silver of a strength of gr. i. to grs. xx. to the onnce 
of water. Repeat the application three times a week. 

Occasionally a fifty per cent solution in water of the gly- 
cerols of tannin will arrest a deep urethral discharge after the 
nitrate of silver fails. Sometimes the passage of a well-oiled 
smoothly- polished sound as large as the meatus will admit, re- 
peated every third day will cure the discharge (Keyes). 

PRESCRIPTIONS FOR GLEET. 

R Potassii permanganatis gr. i iij. 

Aquae destillatse 3j. — M. 

Sig. : Use as injection. — Keyes. 

R Zinci sulphatis gr. vj. 

Tinct. opii 3j. 

Tinct. catechu 3ij . 

A quae rosse ad ^ij . — M. 

Sig.: Use as an injection three times a day. — Witherstine. 

GOITRE. (Simple and Exophthalmic). 

Simple goitre, or Derbyshire neck, as it is generally known 
in England, is very common. In its most usual form it appears 
as a simple bronchocele, or hypertrophy of the thyroid gland. 
They may press upon surrounding parts and cause dyspnoea, 
cough, and difficult deglutition. All these tumors rise and fall 
with the larynx in deglutition (Bryant). 

Cause. — In the Derbyshire district it is generally believed 
that it is from the water impregnated with chalk, lime, and mag- 
nesia, that the disease is produced (Bryant). 

Treatment. — Simple goitres are to be treated on ordinary 
principles by tonics, fresh air, etc. The air of the room should 
be kept iodized by means of solid iodine put into a box with a 
perforated lid. Bryant has seen goitres rapidly disappear under 
this treatment. With the above treatment he, at times, rubs in 
an ointment of the iodide of ammonium, a drachm to an ounce. 
To paint a goitre with the tincture of iodine is useless. Dr. 
Mouat of Bengal, spoke very highly of an ointment of the binio- 
dide of mercury (three drachms to a pound of lard) rubbed in for 



214 A COMPENDIUM OF PRACTICAL MEDICINE. 

ten minutes in the snnshine. He gives his cases of recovery by 
the thousands. Of late years, Bryant injects 20 or 30 drops of a 
mixture of equal parts of tincture of iodine and alcohol, with 
success. In some cases, he reports a cure with one injection. 

Exophthalmic Goitre is a disease characterized by exophthal- 
mus (protrusion of the eyeballs), enlarged thyroid, dilatation of 
the arteries, palpitation of the heart, and anaemia. In Germany 
it is known as Basedow's disease; in England as Graves' disease. 

Causes. — Bartholow gives moral emotions, fright, chagrin, 
reverses of fortune and a peculiar condition of the nervous sys- 
tem as causes. DaCosta says, "This disease is most commonly 
observed in females, and connected with hysteria, neuralgia, and 
uterine disturbance, and is considered to be due to an affection 
of the cervical sympathetic nerve." According to Loomis the 
enlargement of the thyroid body is due to dilatation of its vessels 
and protrusion of the eyeball to a dilatation of the vessels behind 
the globe. 

Symptoms. — This disease may come on suddenly or slowly. 
Palpitation is most often the first symptom. The heart beat is 
always above normal and may reach 200 per minute. A soft 
blowing, murmur is heard at the base and over the carotids. 
Sometimes the goitre is the first symptom observed. The thyroid 
gland occasionally enlarges in pregnancy, but this is accidental. 
Exophthalmus may be the first symptom. There is a staring ex- 
pression. There is more or less fever followed by sweat. The 
patient is nervous, apprehensive, irritable and lachrymose. The 
patient is pale, anaemic, and amenorrhoea is present in most cases 
(Bartholow and Loomis). 

Prognosis. — Must always be guarded (Loomis). 

Treatment. — Traube achieved great success with five grains 
of quinine one day, and ten grains of iron, in the form of Val- 
let's mass, the following day. Good results have been obtained 
from belladonna and ergot. Bartholow has found galvanization 
of the cervical -sympathetic and the pneumogastric, by placing 
the of anode under the ear, and the cathode at the epigastrium 
to be of the highest efficiency. 



GOITEE OOXORRHCEA. 215 

PRESCRIPTIONS FOR QOITRE. 

R Tincture iodinii corap §j. 

Sig. : Apply locally with a brush. Also five to fifteen minims 
in water three times daily internally. (In simple goitre). 

— Bartholow. 
R Ungt. hydrarg. iodidi rubri Sj. 

Sig.: Rub in a piece the size of a pea and expose to the sun. 

(In simple goitre). — Ringer. 

R Potassii bromidi ^ss. 

In pulv. no. xii. div. 
Sig.: A powder in half a tumblerful of water three times daily. 
(In exophthalmic goitre). — Hutchinson. 

GONORRHEA, 

Is a urethral inflammation, a strictly local affection, exerting 
no poisonous action upon the blood, and is the most venereal of all 
the venereal diseases. Urethritis signifies simply inflammation 
of the urethra, consequently gonorrhoea is urethritis, but ureth- 
ritis may not be gonorrhoea. Gonorrhoea alone produces 
gonorrhoea. The term urethritis should be reserved for all 
inflammatory urethral discharges having another origin, and for 
all cases of doubt. "It is better that a hundred of the guilty 
should escape than that one innocent person should be accused. 11 
Experience proves beyond a doubt that urethral inflammation 
attended by an abundant discharge may be acquired by a healthy 
young lover from his equally healthy young mistress, by a young 
husband from his wife, and presenting nothing to differentiate it 
from gonorrhoea (Keyes). 

Causes. — Gonorrhoea is a notoriouslv contagious disease, and 
it may be acquired from any person having it, by the mere con- 
tact of the discharge with the mucous membrane of the urethra. 
The only mucous membranes of the body capable of taking on 
inflammation from the contact of gonorrheal pus are, the ureth- 
ral, vesical, vaginal, uterine, tubal, conjunctival and rectal. .V 
peculiai vegetable parasite, called the gonococcus, is the real 
cause of o-onorrhcea. The three most common forms of urethral 
flow are urethritis, bastard gonorrhoea, and gonorrhoea. Mechan- 
ical violence, such as the rough use of instruments in the urethra, 



216 A COMPENDIUM OF PRACTICAL MEDICINE. 

chemical violence, such as acid urine, cantharides, strongly acid 
or alkaline injections, leucorrhceal discharges, lochial and the 
menstrual now may be sufficient to cause urethritis in a perfectly 
healthy subject. In these cases the patient has a slight uneasy 
sensation at the meatus, a little smarting, and a pearly drop in 
the morning (Keyes). 

BASTARD GONORRHOEA. 

A patient who has previously had gonorrhoea, comes with a 
little oozing from the meatus, perhaps with no itching sensation, 
nor any smarting on urination, and states that (perhaps after 
copious libations of ale, beer, or champagne) he sinned with a 
suspicious party, and that while examining himself on the fol- 
lowing morning, found the little opaline drop. Such a person 
has a damaged urethra, a patch of chronic congestion, or a stric- 
ture, and he has irritated this surface and given himself a dis- 
charge. This is not true gonorrhoea; it is bastard (Keyes). 

Symptoms. — The period of incubation varies from a few 
hours to fourteen days. The first symptom in true gonorrhoea is 
usually noticed on the fifth to seventh day. A tickling, teasing, 
itchy irritation is first felt at the orifice of the urethra. A slight, 
bluish discharge is seen between the lips of the meatus, which 
swell a little and become reddened. A slight stinging is felt on 
urination. The quantity of the discharge increases, and it 
becomes opaline. Greater pain is felt in passing water. The 
meatus feels hot and sore. After the fifth day from its appear- 
ance the discharge becomes much more copious. It gets thick 
and purulent, and soon acquires a greenish color. Pain is now 
felt all along the pendulous portion of the urethra, and the canal 
is very sensitive to pressure. Pain may be complained of in the 
groin, testicle, perineum, cord and back. The stream of urine is 
small, forked, and dribbling on account of the inflammation of 
the urethra, and retention may come on if the patient has pre- 
viously had a stricture. The prepuce may become cedematous, 
occasioning phimosis or paraphimosis. Erections, also, at this 
time become painful, threatening chordee. Chordee is most fre- 
quent during the night and toward morning. After the disease 



BASTARD GONORRHOEA. 217 

has continued at its height for from one to three weeks, the pain 
on urination ceases, and the discharge becomes more watery, and 
finally diminishes to a drop in the morning. 

The Duration of Gonorrhoea is Variable. — A well-managed 
case lasts from three to six weeks as a rule; but the discharge 
may continue for months and even years. A first gonorrhoea is 
the most severe, but is the most certain to get perfectly well. If 
the disease does not get well, it passes into the gleety stage 
(Keyes). 

Complications. — Balanitis, phimosis, chordee, possible reten- 
tion, haemorrhage, epididymitis, orchitis, gonorrhceal cystitis, 
gonorrhceal rheumatism, gonorrhceal ophthalmia and gonorrhceal 
conjunctivitis are the most important (Keyes). 

Treatment. — There are two methods of treatment, the abor- 
tive and the rational. 

The Abortive Treatment. — Consists in hot irrigation to soothe 
the membrane and wash out the poison, and in the use of anti- 
septic, or antiparasitic drugs to destroy the gonococcus. Nitrate 
of silver and chloride of zinc do more harm than good. The 
present favorites are prolonged irrigation and varying strengths 
of the bichloride of mercury. If the abortive treatment is to be 
tried, it should be used within the first twenty-four hours of the 
commencement of an attack. The method by anterior irrigation 
is simply to put a quart of tepid or hot water, at a strength of 
half a grain of bichloride of mercury in twenty -two ounces 
(about 1 in 20,000), into a fountain syringe, and press the blunt 
glass nozzle into the urethra, so that the water shall trickle but 
slowly alongside of the glass nozzle. Instead of the fountain 
syringe a little red soft rubber irrigator, called the universal in- 
jector, may be used. This irrigation is repeated three times a 
day. 

The Hational Method. — Consists first in observing the hy- 
giene of gonorrhoea, which is as follows: Absolute continence 
until at least ten days after the entire cessation of the discharge, 
and avoidance of anything liable to induce sexual excitement. 
No alcoholic stimulants of any sort, and, above all, no malt 
liquor should be drunk during the treatment. 



218 A COMPENDIUM OF PRACTICAL MEDICINE. 

Increasing Stage. — If the case is seen early enough, mild 
bichloride irrigation may be tried. The bicarbonate of soda, or 
better still, the citrate of potash may be given in doses of gr. 
x-xx. during the second hour after each meal throughout the 
entire treatment, to keep the urine alkaline. Occasionally twenty 
grain doses of the bromide of potassium will moderate the ardor 
urinse better than the citrate. 

The following is a good combination: 

R Potassse citratis 3ii--vj. 

Bals. copabise 3iii.-yj. 

Extracti hyocyami fiuidi 3ss.-ij. 

Syrupi acacise §iss. 

Aquae menthse piperita? q. s Siij. — M. 

Sig.: Shake. Teaspoonful in water. 

Another aid to easy micturition is Milton's plan of immers- 
ing the penis in hot water before and during the act. A suspen- 
sory bandage should be worn. When injections are used in the 
increasing stage, they should be very mild ones, as follows: 

R Liq. plumbi subacetatis dil §j. 

Morphia acetatis gr. j. — M. 

Or, 

R Zinci sulphocarbolat gr. i-ij. 

Aquae §j. — M. 

R Zinci sulphatis gr. i-iij. 

Aquse 5j— M. 

(In less acute fom s). Or, 

R Zinci sulphatis gr. i.-iij. 

Liq. plumbi subacetatis dil Sj. — M. 

Or, 

R Aluminis exust gr. x. 

Aquse 3 j .— M. 

Or, if more astringency is required, 

R Acidi tannici gr. v.-x. 

Aquaj Bj • — M. 

A suitable injection may be used two or three times a day. 

Stationary Stage. — This stage lasts from one to three weeks 
with very little change. The treatment of the first stage, with- 
out any injections, must be kept up. Prolonged and frequent 
warm baths are beneficial in this stage. The most difficult part 
of the treatment of this stage is to soothe the painful erections 



GOXOKKHCEA. 219 

and keep off chordee. The best course is for the patient to keep 
his nrine dilute and alkaline, and to immerse the penis for a long 
time in very hot water before retiring. He should sleep, lightly 
covered, on his side, on a hard bed, after a small evening 
meal. Bromide of potassium, in doses of from thirty to sixty 
grains at night in water, repeated once, if necessary, will control 
chordee in some cases. When a patient wakes with chordee, the 
penis should be plunged into the coldest water which is at hand, 
or laid along a piece of iron which has been exposed to the cold. 
He must not "break the chordee." 

Decreasing Stage. — Injections are of great service in the 
stage of decline. Any of those already given may be used. If 
copaiba is well borne and properly administered, it is the most 
efficient of the anti-gonorrhceal internal remedies. Pills or tablets 
containing copaiba, sandal -Avood oil, cubebs and oil of turpen- 
tine sometimes act better than any one alone. They may cause 
an eruption to appear (Keyes). The treatment of the compli- 
cations of gonorrhoea will be found in the proper order. 

PRESCRIPTIONS FOR GONORRCEHA. 

R Balsami copaiba?. 

Spiritus setheris nitrosi. 

Spiritus lavandulae comp, aa §ss. 

Liquoris potassa? 3J . 

Mucil. acacias, q. s., ad §iv. — M. 

Sig. : Shake, and take one teaspoonful. ("Lafayette Mixture.") 

— Charity Hospital. 

R Balsami copaiba? £ss. 

Tinct. ferri muriatis. 

Tinct. eantharidis aa 5ij. 

Glycerinae 3ss. 

Syrupi q. s., ad §iv. — M. 

Sig.: A teaspoonful after meals. — Burnstead. 

R Potassii citratis 3£s-j- 

Sp iritus limonis 5ss. 

Syrupi simplicis §ij. 

Aquas g — M. 

Sig.: A dessertspoonful well diluted three or four times daily, 
fasting. (In the first stage). — Keyes. 



220 A COMPENDIUM OF PRACTICAL MEDICINE. 

R Liq. hydrarg. chlor. corros..( T¥ Vo) Oj. 
Sig. : Distend the vagina with a speculum and cleanse thor- 
oughly with the above solution. Then dust over and rub in iodo- 
form, and tampon the vagina with iodoform gauze. Repeat in 
three or four days. (Iu female.) — Schwartz. 

GOUT. 

In a constitutional malady, inherited and characterized by 
paroxysms of severe pain in small joint — the great toe usually — 
due to the presence of uric acid in the blood, and the deposit of 
the urates in the structure of the joints and throughout the 
body. Gout in the foot is called podagra; in the hand chiragra; 
in the knee gonagra. (Bartholow.) 

Causes. — The gouty diathesis may be inherited or acquired. 
Gout is a disease of middle life. The direct exciting cause is 
over -eating and the use of alcohol. Of the alcoholic beverages, 
the sweet wines and malt liquors are considered more gouty than 
spirits. Lack of exercise, and failure of the excretive power of 
the kidney and lead -poisoning are influential factors. Men suf- 
fer from attacks of gout much more frequently than women. As 
a disorder of the upper classes, gout has had a position of dis- 
tinction, and Sydenham consoled himself for his sufferings from 
gout by the reflection that it is an eminently respectable dis- 
ease, by which more rich men than paupers, more wise men than 
fools are afflicted. It is the large consumption of beer which de- 
velops gout in the laboring classes. Attacks are sometimes at- 
tributed to prolonged intellectual exertion, anxiety of mind, 
bodily fatigue, and exposure to cold, and are more likely to oc- 
cur in the spring and autumn than at other seasons of the year. 
(Bartholow, Flint and Loomis.) 

Symptoms. — Acute Gout. — Usually between midnight and 
four or five in the morning the patient wakes with a burning, 
throbbing pain in the ball of the great toe, which the slightest 
pressure greatly intensifies. The affected joint becomes red, 
swollen, hot and shining; the veins are distended, and it resem- 
bles a joint about to suppurate. The temperature may in a 
severe attack reach 105° F. The pulse is full and bounding, but 
compressible. The pain in the affected joint is so great that the 



GOUT. 221 

patient cannot move it. He tosses about for hours, until finally, 
in a profuse perspiration, falls asleep. In a few hours he 
awakes almost free from pain, and remains so during the da}-; 
but about the same hour the next night there is a recurrence of 
the local pain and the fever. These nocturnal attacks continue 
for two or three days, then the maximum of pain is reached. At 
the end of a week, they have gradually subsided. Following 
the attack, there is a feeling of well-being. During an attack, 
there are anorexia, coated tongue and constipation. The urine 
is scanty and high-colored. The bladder is irritable, and there 
is a scalding sensation on urination. An individual may have 
only a single attack, but usually a second supervenes within a 
year. 

Chronic Gout. — When tophi (deposits of urate of sodium) 
form around the joints, and they become distorted or crippled so 
that walking becomes difficult, it is called chronic gout. Nodules 
of the deposit are frequently seen on the helix of the ear, some- 
times on the eyelids and occasionally on the face. When the 
stomach, intestine, lungs, heart, liver, kidneys and brain are 
gouty, it is called irregular and misplaced gout. Gout is a very 
chronic disease. It sometimes produces subluxation of the 
joints, and this combined with the tophaceous nodules give rise 
to striking deformities (Flint and Loomis). 

Differential Diagnosis. — Gout may be mistaken for rheuma- 
tism. Gout attacks the small and rheumatism the large joints. 
A rheumatic attack is of longer duration than a gouty paroxysm. 
In gout the fever is slight, in rheumatism it is high. In acute 
rheumatism, the heart is frequently involved, in gout rarely. 
The gouty attack coming on at night in the great toe joint is in 
marked contrast to the onset of rheumatic fever. Acute articu- 
lar rheumatism is a disease of early adult life, while gout is rare 
before thirty-five. In gout there is a history of high living, in 
rheumatism there will be a history of exposure or exhaustion. 
In gout there is an excess of uric acid in the blood (uricsemia), 
this is never the case in rheumatism, but is pathogmonic of gout. 
Tophaceous masses occurring in the external ear, varying in size 
from that of a pin's head to that of a split pea, are often of great 
assistance in the diagnosis (Loomis). 



222 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — 1. General Hygiene. — Gouty subjects should 
take systematic exercise iu the open air, especially horse -back 
riding, walking, rowing, etc. A country residence, a warm, dry 
climate, are preferable. The patient should be warmly clad in 
flannel, retire and rise early, and avoid severe physical and mental 
strain. 

2. Dietetics. — Starving will not cure gout. The principal 
articles of diet should be beef, mutton, chicken, bread, milk and 
fruits. All pastry, eggs, tea, coffee, alcohol, cheese, dried meats, 
tomatoes and strawberries should be avoided. Alkaline mineral 
waters, seltzers, vichy and lithia may be taken with and after 
meals. 

3. External Treatment. — The affected part should be 
raised above the body and wrapped in flannel. When the pain 
is intense opium may be applied to the joint. Vapor and Turk- 
ish baths should be taken weekly. 

4. Internal Treatment. — Colchicum and the alkalies are 
our chief remedies during the paroxysm. For thirteen centuries 
colchicum has been used in this disease. Loomis gives one of 
the following pills every three hours until the specific purgative 
action of the colchicum is obtained: 

Be Pulv. ipecac 

Extracti colchi acet 

Hydrarg. protochlor (calomel) ... 

Ext. aloes fid aa gr. j. 

Ext. nucis vomicae gr. \. — M. 

Carbonate of potash, Rochelle salts and citrate of lithia are 
important adjuvants to the colchicum treatment. In chronic 
gout tonics, as iron, arsenic, etc., are usually demanded (Loomis). 

PRESCRIPTIONS FOR GOUT. 

R Magnesii sulphatis 3j. 

Magnesias optimse 3ij. 

Vini colchici rad gj. 

Aquas menthas pip .^x. — M. 

Sig. : A tablespoonful every hour until it operates. — Scudmore. 

R Tinct. iodini ^ijss. 

Glycerinaj 3ij . — M. 

Sig.: A tablespoonful thrice daily. — Granville. 



GUMS GASTRITIS. 223 

R Parald ehy de 3SS . 

Syrupi simplicis giss. — M. 

Sig. : A teaspoonful to a tablespoon ful, well diluted when re- 
quired (for gouty insomnia). — Hodgson. 

R Granulated efferv. lithii citrat ^iv. 

Sig. : One or two teaspoonfuls in water three times daily. 

— Mattison. 

GUMS. (Affections of). 

When the gums are spongy and ill-conditioned, and mani- 
fest a tendency to recede from the teeth, the following local 
application is very serviceable: 

R Aluminis 5j- 

Vini O.j. 

Tinct. cinchonas §ss. 

Tinct. myrrhse 3ij. 

Mel. rosre Sij. — M. 

Sig.: As a mouth wash. — Bartholow. 

The glycerite of tannin is a nsefnl application for spongy 
and bleeding gums. When fetor is present, carbolic acid and 
iodoform are most serviceable. The tincture of benzoin, with 
or without glycerine, is very effective. 

PRESCRIPTIONS FOR SPONGY OR BLEEDING GUMS. 

R Chloral hydratis 

Tinct. cochlearise aa 5iss. — M. 

Sig. : Apply to gums, by means of a pleget of cotton every day 
or two. (For gingivitis of pregnancy). — Pinard. 

R Tinct. myrrhaB 5ii.-iv. 

Aquae vel. infusi cinchonas 31V. — M. 

Sig.: Use as a gargle. (For spongy or ulcerated gums). 

—Phillips. 

R Glycerite acidi tannici 3j. 

Sig.: Apply with camel's hair brush. — Bartholow. 

GASTRITIS. (Toxic.) 

Is an acute inflammation of the stomach, caused by the in- 
gestion of irritant and corrosive poisons. 



224 A COMPENDIUM OF PRACTICAL MEDICINE. 

Symptoms. — Besides the vomiting which occurs immediately 
or very soon after swallowing the irritant, corrosive or toxic sub- 
stance, purging sets in and the same sloughs of the tissues dis- 
charged by vomiting pass also by stool. In the case of corrosive 
sublimate and the metallic salts generally there occur intense 
colic and tenesmus, and the discharges consist of mucus and 
blood and strongly simulate dysentery. Arsenic, the salts of 
mercury, copper, zinc and nitrate of potash, produce an intense 
inflammation. Sausages, hams, cheese, fish, etc., that have under- 
gone decomposition produce, in a few minutes or hours after 
swallowing them a violent gastritis. There is great anxiety and 
depression, a weak, rapid pulse, cold skin, covered with cold 
sweat, intense internal heat and thirst and burning in the gullet 
and fauces (Bartholow). 

Prognosis. — Death may occur from the immediate effects of 
the poison. Recovery may ensue if the injury done is not too 
great for repairs. 

Treatment. — Vomiting is to be encouraged by the free use of 
demulcent drinks. If the toxic agent consists of an acid, as 
speedily as possible, weak alkalies, lime water, soda, common 
soap, etc., should be given. The other poisons require their 
proper antidotes. The stomach pump should be used not only to 
remove the poison remaining, but to thoroughly wash out the 
stomach. To allay the pain, give a hypodermic injection of 
morphine. Ice should be given freely and an ice-bag apruied to 
the epigastrium. No food should be given, but a little cold milk 
at short intervals (Bartholow). 

GINGIVITIS. (See Gums, Affections of.) 

GLAUCOMA. 

This term is used to express a morbid condition character- 
ized by an increase in the hardness of the eye-ball. The word 
glaucoma, literally signifies green, and was employed because in 
certain advanced cases the pupil acquires a greenish hue. The 
standard of ocular tension varies in its physiological limits. 
In women it is normally less than in men, in children than in ad- 
ults. An average of twelve inches of water is normal. The sense 



GLAUCOMA. 225 

of touch must be relied upon for the tension, and one finger of each 
hand is to be lightly pressed upon the eye as when feeling for 
fluctuation in an abscess. When the tension is increased it is 
called plus, when diminished minus tension (Noyes). 

Varieties. — 1. Glaucoma simplex. 2. Glaucoma with inflam- 
mation. 3. Glaucoma hemorrhagicum. 4. Secondary glaucoma 
(Noyes). 

Symptoms. — The simple is the most frequent variety, is in- 
sidious and very slowly progressive, occurs most often after mid- 
dle age and in hypermetropic eyes. The external appearance of 
the eye may be normal except a notable whiteness of the sclera. 
The field of vision will be restricted on the nasal side to a greater 
or less degree. The tension of the eye will be increased. Un- 
commonly strong glasses for reading will be needed. Attacks of 
sudden obscurity of sight for some minutes have taken place. At 
times colored rings will be observed around a lamp or gas flame. 
It is usual for one eye to be affected sometime before the other. 
It may occupy -five to fifteen years for its development, and in 
old persons be mistaken for senile cataract. When the glaucoma 
becomes chronic there will be greatly increased hardness with the 
pupil widely and unequally dilated and fixed, the cornea more 
or less anaesthetic, the pupil will have a dusky or even greenish 
hue, and the globe enlarged tortuous arteries. 

In the inflammatory variety, the person is apt to be taken 
during the night with severe pain in the eye and forehead. 
There may be rise of temperature, rapid pulse and vomiting. 
On inspection of the eye, the cornea may be hazy, the aqueous 
will be turbid, the iris and lens pressed toward the cornea, the 
pupil will be obscured and dilated, and the iris discolored, and 
diminished to a narrow ring. It is not easy to feel the tension 
through the swollen lids, and the pressure will be painful. Vis- 
ion is impaired or wholly lost in a few hours. 

In the hemorrhagic variety, there is effusion of blood in 
the retina, or optic nerve, and sometimes in the vitreous. There 
is a sudden loss of sight, followed by pain and inflammation. 

In the secondary variety, there is increased ocular tension, 
due to some other disease (Noyes). 



226 A COMPENDIUM OF PRACTICAL MEDICINE. 

Prognosis. — The disease tends to total loss of sight. 

Treatment. — The merit of having discovered that iridectomy 
is capable of curing glaucoma, stamps the name of Grsefe with 
undying honor. Up to his time no remedy was known, and now 
no remedy, except an operation, is of positive value, and the 
most favorable results are gained when it is done at an early 
period. Acute attacks occur in chronic glaucoma, and these are 
controlled by combining a 4 per cent, solution of cocaine muri- 
ate with solution of eserine sulphate (gr. i. to Hi.) Each may 
be put up in gelatine wafers, and put in the eye every hour. 
Extremely hot fomentations will give relief, and morphine may 
be given at night. Atropia and all mydriatics should be avoided, 
as they tend to aggravate the symptoms (Noyes). 

GRANULAR LIDS. (See Trachoma). 

GRAVES' DISEASE. (See Exophthalmic Goitre). 

GRAVEL. (See Calculi Kenal ). 

GREENSICKNESS. (See Chlorosis). 

GUMMA. (See Syphilis). 

GIDDINESS. 

Treatment. — Cod-liver oil and quinine is the best treatment 
for giddiness in the aged, that is, when this symptom is not as- 
cribable to serious organic brain disease, but probably to ather- 
omatous changes in the brain vessels, or to a weak heart. 

GLANDERS. 

Is a contagious disease of horses, which may be transmitted 
to man. The nodules of glanders are most frequently found in 
the nose of the horse, but in this animal, as well as in man, the 
nodules may be found in the skin, the mucous membranes, and 
viscera. The nodules usually suppurate (Flint). 

Treatment. — There is no drug which has any influence on the 
disease. Fresh air, tonics, such as quinine and iron, should be 



GLYCOSURIA GONAGKA HJEMATEMESIS. 227 

given. When the nose or throat is the source of trouble, it 
should be washed with water rendered antiseptic by iodine, car- 
bolic acid, Condy's fluid or creosote, nitrate of silver solution, 
tannic acid, etc. Nitro- muriatic acid lotion, and a gargle of 
chlorate of potash should be used in the throat (Bryant). 

GLYCOSURIA. (See Diabetes Mellitus.) 

GONAGRA. (See Gout.) 

H/EMATEMESIS. 

Is vomiting of blood. It is a symptom in a variety of 
diseases. Rrrpture of a blood vessel is one of its essential con- 
ditions. 

Causes. — Injury to the mucous membrane of the stomach by 
traumatism or poisons, diseases of the wall of the stomach, ob- 
struction to the portal circulation, blood-poisoning, cancer and 
ulcer of the stomach, stoppage of the menses in the female, and 
sudden arrest of hemorrhoidal discharges may cause it (Loomis). 

Symptoms. — If the hemorrhage is profuse, the patient has a 
sense of heat and distention in the epigastrium, with nausea and 
vomiting, becomes pale, has a cold clammy skin. If the blood is 
vomited in large quantities immediately after the bleeding has 
occurred, it will be partly fluid and partly coagulated; but if re- 
tained for a time, it will be fluid and have a black or brownish - 
black appearance, with an acid reaction (Loomis). 

Differential Diagnosis.— Haeniateniesis may be confounded 
with haemoptysis or blood- spitting. Haemoptysis is preceded by 
bronchial or pulmonary symptoms, and haeinateinesis by gastric 
symptoms. In haemoptysis there is a sense of constriction across 
the chest, with dyspnoea and cough. In haematemesis there is 
nausea, with a sense of oppression and distention in the epigas- 
trium. In haemoptysis, blood is coughed up in mouthfuls/bright 
red, frothy, alkaline and mingled with sputa. In haematemesis, 
blood is vomited more or less profusely, is dark colored, mixed 
with food, coagulated, and often acid. In haemoptysis 
there is a sense of trickling behind the sternum, and for a few 
days after the hemorrhage, small blood-spittings (Loomis). 



228 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — During the hemorrhage the patient must be 
kept absolutely quiet, in a horizontal position. Ice should be 
taken freely, and ice-bags applied to the epigastrium. Morphine 
and ergotin may be given hypodermically. Brandy may be 
given by the rectum or hypodermically. Milk is the only diet 
allowed for the first week (Loomis). 

PRESCRIPTIONS FOR H^EMATEMESIS. 

R Liquor ferri subsulphatis £ss. 

Sig. : One or two drops in ice water frequently. — Bartholow. 

R Ferri et ammonii sulphatis gr. xL. 

Aquae cinnamomi §iv. — M. 

Sig. : A teaspoonful every two or three hours. — Hartshorne. 

R Ergotin gr. xij. 

Aquse destillatse 3J . — M. 

Sig.: Five to ten minims hypodermically every three hours. 

— Ringer. 

R Acidi gallici . gr. x. 

Acidi sulphuric! dil ITT. x. 

Aquae §j. — M. 

Ft. haustus. 
Sig : To be repeated in four to six hours if necessary. — Bruton.. 

R Tincturse hamamelis £ss. 

Sig. : Two to four drops every two hours. — Ringer. 

R Acidi tannici 5j- 

A quae Sj. — M. 

Sig.: A teaspoonful frequently. — Bartholow. 

HEMATURIA. 

Is the passage of urine containing blood. The origin of the 
blood may be at any point from the meatus to the maljoighian 
tuft. It is a symptom and not a disease. 

Causes. — Active and passive hyperemia of the kidney, acute 
suppurative nephritis, tuberculosis and stone in the kidney and 
pyelitis are causes. Turpentine, cubebs, copaiba, cantharides, 
etc., may cause blood in the urine. The causes in the ureter are 
cancer, polypi, ulcers and calculi. The causes in the bladder are 
cystitis, cancer, abscesses in the wall, polypi, stone, rupture,. 



HEMATURIA. 229 

tuberculosis, etc. The causes in the urethra are urethritis, chor- 
dee, cancer, fracture of the penis, enlarged prostate, polypi, 
caustic injections, chancre and chancroids, phimosis, impacted 
stone, etc. The general causes of hseniaturia are acute infectious 
diseases, as fevers, especially malarial, scurvy and purpura. 
Hsematuria is endemic in some localities, as South America and 
Isle of France, due to a parasite (Loomis). 

Symptoms. — The urine may be almost black and loaded with 
clots, or it may be only slightly smoky or pinkish in color. It 
is albuminous. The blood usually comes from the urethra, the 
bladder, or the kidneys. To determine the source of the blood 
the following rules may be observed: Urethral hemorrhages are 
independent of micturition, as only a residue of blood is washed 
out at the beginning of the now of urine, and some of the blood 
will reach the meatus between the acts of micturition. Blood 
effused into the urethra clots there and assumes the shape of a 
leech, and usually comes with the first gush of urine. If the 
bladder is the source of the hemorrhage, the blood flows only at 
the time of micturition, and follows the discharge of urine. The 
blood does not equally diffuse through the urine, so that the first 
passed is clear or nearly so, but at the end of the act the urine 
is much more deeply colored, or pure blood, in a liquid form, or 
in clots is voided. There is usually pain over the bladder, with 
a frequent desire to pass water, and a stoppage in doing so. In 
renal hemorrhage, there is pain in the lumbar region, and the 
blood is mingled with the urine, and is commonly as profuse at 
the commencement as at the end of micturition. Should blood 
globules, albumen, casts, and blood moulded in the form of renal 
tubules be found in the urine, renal disease may be regarded as 
the cause of the haeinaturia. 

Treatment. — When the haeruaturia is profuse or persistent, 
the patient should be placed in a recumbent position, ice-bags 
applied over the seat of the hemorrhage, and haemostatic reme- 
dies used, such as gallic or tannic acid, ergot, acetate of lead, and 
astringent ferric preparations (Loomis). 



230 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR HEMATURIA. 

R Mucil. acaciae q. s 

Syrupi simplicis Siij . 

Olei gaultherise gtt. viij. 

Olei terebinthinse 5ss. — M. 

Ft. emulsio. 
Sig. : One to three teaspoonfuls every three hours. — Hunter. 

R Acidi gallici 3ss. 

Acidi sulphurici dil 5j. 

Tinct. opii deodorat 5j. 

Infusi digitalis Siv. — M. 

Sig. • A teaspoonful every four hours. — Druitt. 

R Tinct. ferri muriat ITTxxx. 

Tinct- digitalis ITTxv. 

Aquae menthse pip §iss. — M. 

Ft. haustus. 
Sig.: To be repeated every four hours. — Aitkem. 

HEMOPTYSIS. 

Is tlie spitting of pure blood. The sputa are streaked with 
blood in bronchitis, intimately admixed with blood in pneumonia, 
(the rusty colored matter), yet we do not call this haemoptysis 
(Loomis). 

Causes. — Pulmonary congestion, pulmonary apoplexy, and 
inflammation of the lungs and bronchi may cause spitting of 
blood; but hemorrhage from the bronchial tubes is by far the 
most frequent cause of blood spitting or haemoptysis. Ulcera- 
tion, over distension, and weakness of the capillary walls of the 
bronchial mucous membrane are the chief causes of bronchial 
hemorrhage. Bronchial catarrh, phthisis, inhalation of irritating 
gases or vapors, passive hyperemia of the lungs from obstructive 
heart disease, intense active hypersemia, the violent coughing of 
bronchitis, pertussis, and pneumonia, and suppression of the 
menses may cause it. Ulceration of an exposed vessel in ad- 
vanced phthisis will cause it (Loomis). 

Symptoms. — All bronchial hemorrhages are attended by the 
spitting of bright red, frothy, arterial blood. They may come 
on suddenly without any warning, but usually there is a sense of 



HAEMOPTYSIS. 231 

constriction at the upper portion of the chest. Cough may or 
may not precede the hemorrhage. Usually the patient feels as 
if some fluid had suddenly commenced trickling under the ster- 
num, and he notices an unusually sweetish or saltish taste in the 
mouth. The blood in the throat brings on fits of coughing. 
Blood may be expectorated only for a few hours, or for several 
days. The amount varies from an ounce to a pound. The 
patient has an anxious expression, becomes tremulous and often 
faints. Hemorrhage from the lungs weakens a patient. The 
patient goes on coughing for a few days, expectorating small 
dark coagulated masses of blood, or blood- streaked sputa. 

Sometimes the hemorrhage is so profuse that the blood 
spouts out at the mouth and nose, and this points to rupture of 
an aneurism (Loomis). 

Differental Diagnosis. — Haemoj)tysis may be confounded with 
epistaxis, pulmonary apoplexy, haematemesis, and aneurisms 
rupturing into the air passages. 

In epistaxis, the blood is always coagulated and dark- colored. 
It is not attended or followed by a cough, and blood can always 
be detected in the nostrils and posterior nares. 

In haematemesis, the blood is black, contains no air, has an 
acid reaction, is mixed with articles of food, and is vomited; in 
haemoptysis the blood is bright red, contains air, has an alkaline 
reaction, and is coughed up, while there is no nausea. When an 
aneurism ruptures into a bronchial tube, the hemorrhage is gen- 
erally profuse, and it is soon followed by death. The blood 
spurts out in jets. There is a history of aneurism. If the blood 
comes from the mouth or fauces close inspection will reveal the 
fact. 

Haemoptysis should always excite a strong suspicion of tub- 
erculous disease (Loomis and Flint). 

Prognosis.— As to final result is always unfavorable, but 
haemoptysis rarely proves immediately fatal (Loomis). 

Treatment. — Absolute rest in a cool room, with the patient 
in bed and not allowed to sit up, turn over, or even speak above 
a whisper, is of the greatest importance. If the cough continues, 
full doses of opium must be given. Ergot, tannin, gallic acid, 
acetate of lead, spirits of turpentine, persulphate of iron, or a 



232 A COMPENDIUM OF PRACTICAL MEDICINE. 

mouthful of common salt may be administered. When the pulse 
is full and strong Loomis uses aconite; when it is weak, he em- 
ploys morphia hypodermically. Ice-bags may be applied to the 
chest, and the patient urged to eat ice, and drink freely of cold 
drinks. Counter irritants are serviceable, such as mustard plas- 
ter, Hying blister, or turpentine (Loomis and Flint). 

PRESCRIPTIONS FOR H/EMOPTYSIS, 

Jfc Extracti ergotse fid gj. 

Olei gaultherise gtt. iv. — M. 

Sig. : A teaspoonful every hour at first ; then every four to six 
hours. — Ringer. 

j& Infusi digitalis ^iv. 

Sig.: A tablespoonful every hour until the pulse is reduced. 

— Brinton. 

j& Sodii chloridi <|rj. 

Sig. : Take half teaspoonful dry. Repeat till nausea occurs. 

— Ringer. 

{& Pulv. aluminis $j. 

Sacchari albi 3ss. 

Pulv. ipecac comp gr. xx. — M. 

In pulv. no. vi. div. 
Sig.: One powder every two hours. — Skoda. 

(& Plumbi acetatis : gr. xx. 

Pulv. digitalis gr. x. 

Pulv. opii gr. v. — M. 

Ft. massa et in pil no. x. div. 
Sig.: One pill every four hours. — Bartholow. 

HAY=FEVER, 

Called also summer catarrh, hay- asthma, rose- cold, June- 
cold and autumnal catarrh, is an acute catarrh of the upper air 
passages chiefly, occurring at a fixed period annually, and disap- 
pearing after a variable duration (Bartholow). 

Causes. — Emanations from roses, and new mown hay, or 
grasses, and the pollen of wheat, rye, oats and barley may excite 
the disease. When the neurotic temperament is present and a 
special tendency exists, various exciting causes, as heat, dust, etc., 
may excite summer catarrh (Bartholow). 



HAY -FEVER. 233 

Symptoms. — There are two forms in which the disease mani- 
fests itself — the catarrhal and the asthmatic. Hay -fever is dis- 
tinctly periodical. It occurs at certain seasons only. In the 
catarrhal form, the onset is sudden in the majority of cases. The 
first symptom is an itching of the eyes, nose, behind the posterior 
nares, and the palate. This is followed by the flow of a trans- 
parent serous fluid, and then sneezing begins. Henry Ward 
Beech er, himself a sufferer from the disease, describes the sneez- 
ing as follows: " You never before even suspected what it really 
was to sneeze. If a pane of glass is gone, you sneeze. If you 
look into the sunshine, you sneeze. If you sneeze once, you 
sneeze twenty times. It is a riot of sneezes. First a single one, 
like a leader in a flock of sheep, bolts over; and then, in spite of 
all you can do, the whole flock, fifty by count, come dashing over 
in twos, in fives, in bunches of twenty." The eyes water, and 
the conjunctiva reddens; the nasal mucous membrane swells and 
becomes hypersemic; the breathing is carried on by the mouth. 
There is a sense of heat and burning in the nose and eyes, and 
pain shoots through the orbits. The throat is hot, dry and 
swollen. 

In the asthmatic form, the larynx and bronchial tubes are 
swollen and hypersemic. There is a croupy, or a wheezy bron- 
chial cough. The patient is unable to lie down, struggles for 
breath, is pale, and covered with a cold sweat. 

The duration of hay-fever is from a few days to three 
months, the average being about six weeks (Bartholow). 

Treatment. — There is no remedy so effectual as removal from 
the hay fever zone in time to prevent the attack. The patient 
may be exempt from the attack if on the ocean. The White 
Mountains, the Catskills, the Adirondacks, the Rocky Moun- 
tains, and the highest points of the Alleghenies, and many 
places by the seashore can be resorted to with confidence of re- 
lief. Quinine has been more useful than any other agent, and 
should be given in five grain doses three times a day for a week 
before the attack, and when the first symptoms of irritation of 
the nares are felt, a solution of the muriate should be applied to 
the nares. 



234 A COMPENDIUM OF PRACTICAL MEDICINE. 

When the disease lias begun, the best results are obtained 
from fifteen grain doses of iodide of potassium every four to eight 
hours. Morphine gr % and atropine gr 2 i- - are good when there 
is much secretion. Local applications are more effectual than 
internal remedies. 

R Acidi carbolici giij. 

Tinct. iodi 3 v. — M. 

Sig. : Add from one to five minims to a gill of water, and apply 
to the nose by means of a syringe. 

A few drops of the tincture of iodine may be placed in a 
warm vial, and cautiously inhaled. 

Cocaine in solution or in the form of a pellet placed along- 
side the septum and allowed to dissolve slowly, has proved to be 
the most effective agent for affording relief. The dose will be 
i _ i g r (Bartholow). 

PRESCRIPTIONS FOR HAY=FEVER. 

R Cocaine muriatis gr. v. 

Aquas destillatse 3ij. — M. 

Sig.: Apply to nasal passages with a camel's hair brush. — Sajous. 

R Syrupi acidi hydriodici 5iv. 

Sig. : A teaspoonful every two hours. — Judkins. 

R Quinine muriatis gr. iv.-viij. 

Aquse Sj • — M. 

Sig.: Apply to the nares with an atomizer. — Bartholow. 

R Antipyrin 5ss. 

Syrupi aurantii cort Sj. 

Aquas ad Siij - — M. 

Sig.: A teaspoonful one to three times a day. — Cheatham. 

HEADACHE. 

Called also cephalalgia, is properly a form of neuralgia, as 
it can only be referred to the sensory nerves supplying the men- 
inges and scalp. It is a symptom occurring in many affections, 
such as active cerebral congestion, cerebral meningitis, the essen- 
tial fevers, acute dyspepsia, syphilitic periostitis of the head, in- 
tracranial tumors, etc. Headache is extremely common. It 



HEADACHE. 235 

occurs in paroxysms, lasting usually from twelve to twenty- four 
hours (Loomis and DaCosta). 

Varieties. — 1. Congestive. 2. Astigmatic. 3. Headache from 
poisoning. 4. Headache in diseases of the brain. 5. Nervous, 
or neuralgic. 6. Sick-headache. 7. Sympathetic. 8. Uraemia 
9. Anaemic (DaCosta). 

Causes. — An optical defect, as hyperopia, or astigmatism may 
cause an intense headache. A severe headache may be depend- 
ent upon decayed teeth, and will disappear with their removal. 
In acute inilammation of the brain, the pain is agonizing and 
continuous, and is associated with fever, vomiting and delirium. 
In abscess of the brain, and in softening, the headache is less 
violent, and is accompanied by signs of disturbed intellection 
and of deranged motion. In tumor of the brain, the headache 
is apt to be severe and paroxysmal, but intellection is not at 
first much affected. 

In congestion of the brain the pain is dull, increased by 
stooping or lying down, by long sleep, and by bodily or mental 
fatigue, with flushed face and throbbing of the arteries of the 
neck. A form of congestive headache, apt to be relieved by 
bleeding at the nose, is often seen in young people at the age of 
puberty; the attacks are brought on by running or other violent 
exercise. 

In diseases of the meninges, the pain is constant and fixed, 
and sometimes very sharp. 

Nervous or neuralgic headache is most common in women, 
especially in anaemic women. It is very severe, yet of short 
duration. 

Sympathetic headache is found mainly in connection with 
disorders of the alimentary tube, and of the uterus, and is often 
worse in the morning, before food has been taken. Headache 
may be dependent upon various poisons, as in Bright's disease, 
the retention of a large quantity of urea in the blood becomes 
the source of persistent pain in the head. Headache is common 
in lead poisoning, in opium-eaters, in drunkards, and after the 
use of strychnine and quinine. Headache increased by the erect 
posture and relieved by lying down bespeaks an anaemic condi- 
tion of the brain. Sick-headache, or heniicrania, or migraine, or 



236 A COMPENDIUM OF PRACTICAL MEDICINE. 

megrim, lias symptoms which set it apart. The pain is usually 
attended by nausea and vomiting, is generally at first one-sided, 
and the patient vomits bile (DaCosta). The vomiting often 
ends the attack. The face is flushed and red and light is hurtful 
to the eyes. The paroxysms may last for a few hours, or a day 
or two. Women are especially liable to attacks about the men- 
strual period. Attacks may occur every few days, every week, 
or every month, and in many they are induced by errors of diet. 
They usually disappear after the age of fifty. 

Headache of gastric or hepatic origin is commonly frontal 
and throbbing in character. Headache at the vertex is symp- 
tomatic of cerebral disturbances, or it is due to reflex irritation 
starting in the pelvic organs of the female. Pain in the occipital 
region is mostly an accompaniment of disorders of circulation, 
and vaso motor spasm and anaemia in particular. The pain of 
cerebral compression, or tumor, is generally localized, persistent, 
and very intense (Loomis and Bartholow). 

Treatment. — In anaemic headache the inhalation of nitrite of 
amyl is serviceable. In congestive headache, ergot affords relief. 
The bromides and hydrate of chloral are sometimes efficacious. 
The inhalation of a little chloroform is sometimes efficient. 
Evaporating lotions to the head — alcohol, spirits, vinegar, or 
ether — in some cases afford marked relief. Hot water to the 
head sometimes relieves. Strong coffee or tea affords marked 
relief in some cases. The faradic and galvanic currents may be 
tried. During the intervals, nux vomica in small doses, arsenic, 
or small doses of quinia may be tried. The hypophosphites and 
cod-liver oil, continued steadily for months, have done good in 
debilitated subjects. Tobacco smoking should be prohibited. 

PRESCRIPTIONS FOR HEADACHE. 

R Potassii citratis gr. xx. 

Spiritus juniperi oj. 

Spts. setheris nitrosi THxx. 

Infusi scoparii Sj. — M. 

Sig. : To be taken thrice daily. (Uraemic form.) — W. H. Day. 

R Potassii acetatis 3vj. 

Infusi digitalis *Svj. — M. 

Sig. : A tablespoonful every third hour. (Uraemic headache.) 



HEART BURN HEMICRAXIA HEMIPLEGIA. 237 

R Gran, efferv. bromo caffeine Siv. 

Sig. : A teaspoonful in half glass of water — cold. Repeat in half 
an hour if necessary. (Nervous form.) — R. V. Mattison. 

R Zinci phosphidi gr. iij. 

Ext. nucis vomicae gr. x. 

Confect. rosse q. s — M. 

Ft. massa et in pil. no. xxx. div. 

Sig. : One after each meal. (Nervous form.) — Fordyce Baker. 

HEART BURN. (See Acidity.) 

HEMICRANIA. (See Headache.) 

HEMIPLEGIA. (See also Paralysis.) 

Is a motor paralysis of one side of the body. It is generally 
the result of the lesion above the medulla, and most frequently 
of the corpus striatum, but may result from injury to a cerebral 
hemisphere or eras. It occurs on the side opposite to the dis- 
ease or injury. (Loomis). 

Causes. — Its most frequent cause is apoplexy, but it may be 
due to other cerebral injuries or disease, and is frequently func- 
tional. The cerebral causes are : Compression from bone, blood, 
pus, or inflammatory exudations, tumors, especially carcinoma 
sarcoma and gummata. Partial anaemia from thrombosis, embol- 
ism, softening, aneurism and apoplexy. Encephalitis, abscess, 
atrophy and sclerosis. 

The spinal causes are as above, or any disease affecting a, 
lateral half of the cord. 

The functional causes are : Hysteria, chorea, epilepsy, diph- 
theria, malaria, poisons, etc. The muscles of the arm and leg are 
chiefly affected, while those of the trunk and neck often escape 
entirely. Of the cranial nerves the third, fourth, fifth, sixth and 
seventh and twelfth may suffer. If the fifth nerve suffers there 
will be anaesthesia of the face and cornea and paralysis of the 
muscles of mastication on the affected side. If the facial nerve 
suffers, the face becomes a blank and motionless, and the mouth 
is drawn toward the healthy side. If the twelfth nerve suffers 
the tongue will then be protruded with the tip pointed toward 
the affected side. The history of the case, the matter of in\a- 



238 A COMPENDIUM OF PRACTICAL MEDICINE. 

sion, and other symptoms, will usually give a clue to the location 
of the lesion. 

It has been noticed that paralysis caused by lesions in the 
motor tract above the ganglionic cells in the anterior cornua of 
the cord is seldom followed by much muscular atrophy or more 
than would be caused by inactivity, while disease affecting these 
cells or the peripheral nerve -trunks produces marked muscular 
atrophy as well as paralysis (Loomis). 

Hemiplegia may be feigned: but the results of electricity, 
and the test proposed by Hughlings Jackson, that the arms do 
not, as in real hemiplegia, fall forward when the patient stoops, 
but are retained at the side, will usually detect the fraud (Da 
Costa). 

Treatment. — In hemiplegia the constant current may be ap- 
plied to the brain, for the purpose of improving its nutrition, 
and the faradic current to the muscles, to prevent wasting and * 
loss of function from disease. In faradizing the muscles in a 
case of hemiplegia, a current of just sufficient intensity to cause 
contractions should be used. The hypodermatic injection of 
strychnine into the paralyzed muscles, after the local troubles 
have ceased, is very efficacious. In hemiplegia and other forms 
of paralysis due to intracranial lesions, the indications for the 
treatment by massage are a lowered state of the nutrition of the 
paralyzed parts, coldness and blueness of the skin, wasting and 
contracted muscles, ulcerations, etc (Bartholow). 

HEART DISEASES. (See each particular affection). 

Treatment in General. — Overaction of the heart, with hyper- 
trophy, and without valvular lesion, is benefited by a quantity 
of aconite sufficiently large to moderate the cardiac movements 
(Bartholow). 

In simple hypertrophy of the heart, without valvular lesion, 
the tincture of veratrum viride diminishes the overaction and 
gives relief. The irritable heart dependent on the excessive use 
of tobacco, on mental excitement, and on overstrain, is relieved 
by five drops of the tincture of veratrum viride three times daily 
(Bartholow). Digitalis is indicated when the action of the 
heart is rapid and weak, and the arterial tension low. 



HEART DISEASES — HEMORRHAGES. 239 

Jfc Extracti ergotse fluidi ^iiiss. 

Tincturae digitalis gss. — M. 

Sig. : A teaspoonful three times a day. (In enlarged heart with- 
out valvular lesion). — Bartholow. 

jfc Ferri redacti 

Quininse sulphatis 

Pulveris digitalis (English). ...aa...gr. xx. 

Pulveris scillse gr. x. — M. 

Ft. pil. no. xx. 
Sig. : One pill three or four times a day. (In irritable heart of 
anaemia and chlorosis, and in fatty heart). — Bartholow. 

In dilated heart, with difficult breathing, and general oedema, 
the hypodermic injection of morphine, the eighth to the sixth of 
a grain, two or three times a week, possesses a high degree of 
utility (Bartholow). 

To stimulate the action of the heart when it flags, the am- 
monia preparations have an undoubted effect. It is a most 
common practice to inhale ammonia to prevent that depression 
of the heart's action called fainting (Bartholow). 

|fc Cocaini hydrochloratis gr. yj. 

Aquse destillatse §iij. — M. 

Sig.: • A teaspoonful three times daily. (In nervous cardiac de- 
bility). — Rosenbach. 

jfc Tincturse digitalis oij- 

Spiritus chloroformi 5 v. 

Infusi buchu ad gxij. — M. 

Sig. : Two tablespoonfuls in a wineglassful of water three times 
daily. (In simple cardiac debility). — Fothergill. 

J& Strychnise sulphatis gr. j. 

Aquae §j. — M." 

Ft. sol. 
Sig. : Eight to fifteen minims hypodermically. (For exhausted 
heart muscle and its nerves). — Habershon. 

|& Vini coca3 Mariani 0. j. 

Sig. : A wineglassful three or four times daily (In overstrain of 
heart). 

HEMORRHAGES. 

Treatment. — Digitalis has an undoubted power to arrest 

hemorrhage. The mechanism of its action is similar to that of 



240 A COMPENDIUM OF PRACTICAL MEDICINE. 

ergot; it slows the action of the heart and contracts the arte- 
rioles. 

R Infusi digitalis §ij. 

Tincturse kramerise 

Ext. ergotse fiuidi aa gj. — M. 

Sig. : A tablespoonful pro re nata. — Bartholow. 

Active hemorrhage, occnrring in the plethoric, is sometimes 
stopped by fnll medcinal doses of veratrnm viride (tincture 
2\l v). The value of acetate of lead in various forms of hem- 
orrhage has been attested by an immense clinical experience. In 
haemoptysis and haematemesis it is a most useful haemostatic, 
given in five grain doses every three hours. Chloride of barium 
in dose of gr., 1-10-gr., ss. has proved very useful in hemorrhage. 
Ipecac is a most valuable remedy in haemoptysis, epistaxis, men- 
orrhagia, postpartum hemorrhages, etc. It arrests all kinds of 
hemorrhage, and should be given in frequently repeated doses 
until vomiting occurs. 

R Extracti ipecac fiuidi... gij. 

Extracti ergotse fiuidi ^iv. 

Extracti digitalis fid 31'j. — M. 

Sig.: Thirty minims to a teaspoonful at a dose as required. 

— Bartholow. 

The fluid extract of ergot will often arrest the bleeding of 
hemorrhoids and cause such a contraction of the vessels in recent 
cases, as that the symptoms may entirely disappear. Ergot is 
used in various forms of hemorrhage. It is used in epistaxis, 
haemoptysis, renal, intestinal and uterine hemorrhage. One to 
two drachms of the fluid extract, given every half hour or hour, 
will be necessary in urgent cases. In haemoptysis the ergot may 
be given as follows : 

R Extracti ergotse fiuidi Siij. 

Extracti ipecac fiuidi. 

Tinct. opii deodorat aa gss. — M. 

Sig.: A teaspoonful every half hour or hour. — Bartholow. 

In renal hemorrhage, the following is useful: 

R Extracti ergotse fiuidi 

Tincturse kramerise — aa 5ij • — M. 

Sig.: A teaspoonful every hour or two. — Bartholow. 



HAEMORRHAGE. 241 

In passive hemorrhages, the following is useful: 

R Olei terebinthinse jfiij. 

Extracti digitalis fid 5j- 

Mucil acacise Sss. 

Aquas menthse pip Sj. — M. 

Sig. : A teaspoonful every three hours. — Bartholow. 

The following mixture is very effective in menorrhagia, he- 
maturia, purpura hemorrhagica and the hemorrhagic diathesis: 

R Acidi gallici Sss. 

Acidi sulph. dil 3j. 

Tincturse opii deodor 3j- 

Infusi rosse comp , Siv. — M. 

Sig.: A tablespoonful every four hours or oftener. — Bartholow. 

Astringents, such as alum, acetate of lead, iron subsulphate 
and chloride, sulphuric acid, tannin, gallic acidi and the vegeta- 
ble astringents are employed locally and systemically in the 
various kinds of hemorrhage. When the blood pressure is high 
and cerebral hemorrhage threatened or proceeding, venesection,, 
or leeches, or purgatives (saline) are the most effective. 

In uterine hemorrhage, full doses of the fluid extract of 
ergot will give good results. Ipecac carried to nausea merely is 
highly effective. Digitalis and sulphuric acid diluted in small 
doses frequently repeated are highly serviceable. 

Monsel's solution one part and water three parts may be 
injected into the uterine cavity to arrest bleeding, if the os is 
patulous (Bartholow). 

PRESCRIPTIONS FOR HEMORRHAGE. 

R Argenti nitratis fusee q. s 

Sig. : Wipe the wound dry, and apply locally. (In leech-bites.) 

— Ringer. 

R Acidi acetici dil Svj. 

Sig. : Apply locally. (For leech-bites, piles, cuts.) — Ringer. 

R Tincturas opii 5j- 

Spts. vini gallici 5j. — M. 

Ft. haustus. 
Sig. : To be taken at once. (In flooding after delivery, with 
uterine exhaustion.) — Ringer. 



242 A COMPENDIUM OF PRACTICAL MEDICINE. 

R Tincturse hsemamelis Siv. 

Sig. : Use pure or diluted. (In cuts, leech-bites, oozing from 
wounds, etc.) Also internally three minims every three hours. 

— Ringer. 

HEMORRHOIDS, OR PILES. 

Are small tumors at the anal verge. Kinds, bleeding and 
non- bleeding. The bleeding piles are generally the internal, 
and composed of a highly vascular tissue involving the mucous 
membrane of the rectum and the submucous tissue with enlarged 
arteries and veins. If the artery is enlarged the tumor has a 
bright-red aspect and is called the strawberry pile. If the vein 
is enlarged, the tumor has a dusky hue. 

The non -bleeding, or external piles, are composed of 
loose folds of the skin that surround the anus, or a varicose, in- 
flamed or ruptured vein. The treatment of external piles is 
simple, and excision is the only radical cure. 

In the early stage of the affection local cleanliness, and ab- 
stinence from highly seasoned food and strong wines, are mostly 
sufficient. The bowels must be kept clear. When local irrita- 
tion exists, an ointment of zinc and the extract of belladonna is 
-very useful (Bryant). 

Causes. — Constipation, sedentary habits or occupations, and 
high living appear to have the strongest influence. Pregnancy 
and abdominal tumors are causative. Internal piles are very 
insidious in their growth — bleeding is often the first symptom 
that attracts attention. 

Treatment. — Is both medicinal and surgical. All piles do 
not require removal. The medical or palliative treatment of 
piles means attention to diet, the giving up of high living and 
strong drinks, and the taking of simple, nutritious food in mod- 
eration. The bowels should be kept open by purgatives, or 
enema. Absolute local cleanliness should always be observed. 
By these different means an attack of piles may pass away never 
to return. When the piles are inflamed, hot or cold applications 
are useful. 

Surgical Treatment. — Unless the general condition of the 
patient forbids, all piles, external or internal, should be removed. 
External piles ought to be removed by abscission. Internal 



HEMORRHOIDS. 243 

piles ought never to be excised, but destroyed by the galvanic or 
actual cautery, crushing, or the ligature. In Paris a plan of 
treatment has been successful which consists of forced anal dila- 
tation, either by the thumbs, or by means of a dilator, the piles 
withering after one full dilatation of the anus. 

The Ligature Method. — -The surgeon grasps the base of the 
pile to be ligatured by a pair of forceps, and separates the pile 
from the skin and submucous tissue by scissors, and then trans- 
fixes it with a needle armed with a double silk ligature. He 
should then divide the cord and tie the pile tightly in halves, and 
cut off half of the strangulated portion. The other masses are 
treated similarly. The ligatures slough off about the seventh or 
tenth day. 

After Treatment. — After the operation an oj3iate may be 
given. The bowels should be left undisturbed for two days, 
when a dose of castor- oil or enema may be given. If oedema of 
the parts follow, ice may be applied or a lotion of lead and 
opium. 

The Cautery Method. — The galvanic cautery is preferable to 
the actual. The anus is to be forcibly dilated, and each mass is 
then to be seized in turn by a clamp, and the projecting half of 
each mass must then be cut off with scissors, the surface wiped 
dry, and the cautery, heated to a white heat, applied to the sur- 
face, the whole projecting portion being burned clown to a level 
of the clamp. The clamp should be removed so as not to dis- 
turb the eschar. AYhen all the piles have been treated, the 
whole projecting mass may be returned into the rectum with the 
fingers well greased, and a suppository of opium or morphine in- 
troduced at this time to soothe the pain. The after treatment is 
the same as in ligature. 

Treatment by Crushing. — A clamp, is to be adjusted as in 
the operation for cautery, and the protruding pile cut off with 
scissors. The clamp which is very strong, is left on the pile for 
one minute. 

Treatment by the Subcutaneous Injectfon of Carbolic Acid.— It is 
applicable to internal piles alone, and one pile should be treated at a 
time, about a week being allowed between the operations. Al unit 
one to six drops, of a solution of carbolic acid in thirty of olive 



244 A COMPENDIUM OF PRACTICAL MEDICINE. 

oil or glycerine should be injected with a hypodermic syringe 
into the pile, which turns white, and in successful cases withers 
without pain or sloughing. 

Dr. A. A. Smith of New York, gives the following: 

R Acidi carbolici . gr. vj . 

Cocaini hydrochloratis gr. x . 

Glycerini giij . — M. 

Sig.: Inject ten minims into the tumor or pile. 

When a fissure or painful ulcer coexists with hemorrhoids,, 
its base should be lacerated by forcible dilatation of the anus. 

In operating on piles the surgeon must be careful not to 
take away too much tissue. In rectal operations, it is probably 
advisable to use anaesthetics in all cases (Bryant). 

PRESCRIPTIONS FOR HEMORRHOIDS. 

R Ferri sulph gr. xx. 

Pulv. aloes Soc 

Extracti opii aq 

Sapo cast aa gr. x. — M. 

Ft. pil. no. xx. 
Sig. : One pill morning and evening: — Fordyce Baker. 

R Tincture nucis vomica? 33. 

Ext. ergotse fid gj,— M. 

Sig.: A teaspoonful three or four times a day. (For bleeding 

piles and post partum piles). — Bartholow. 

R Tinct. hamamelis giv. 

Sig. : One-half to one teaspoonful in an ounce of cold water, in- 
jected into the rectum daily before rising. Also take internally two 
to five minims three times daily. — Ringer. 

R Acidi nitrici Sss.-j. 

AqusD §viiL — M. 

Ft. lotio. 
Sig.: Apply as a wash. (In bleeding piles). , — Ringer. 

HEPATITIS. (Interstitial). (See Cirrhosis). 

HEPATITIS. (Circumscribed Suppurative.) 

Is an abscess of the liver. 

Causes. — Pyemic infarction, phlebitis, the result of opera- 
tions on the intestines (as for prolapsus ani, hemorrhoids, and 



HEPATITIS HERPES. 245 

strangulated hernia), and intestinal traumatism, may give rise to 
abscess of the liver. Hot climates, miasmatic influences and 
dysentery are regarded as causes of abscess of the liver. Ulcera- 
tion of the stomach, of the intestine, gall-bladder and appendix, 
ulcerative endocarditis, and cancer of the stomach are often 
associated with abscess of the liver. Obstruction to the common 
duct by worms or calculi may lead to ulceration followed by 
abscess of the liver (Loomis). 

Symptoms. — A slight feeling of chilliness, sometimes a dis- 
tinct chill, is followed by dull pain and weight in the right 
hypocondrium, the pain often radiating to the tip of the right 
shoulder. The chilly sensations recur. The pain increases and 
is aggravated by position and pressure. The tongue is brown 
and furred, there is loss of appetite, slight nausea, and often 
vomiting. There is dyspnoea and a short dry cough resembling 
that of pleurisy. With the formation of the abscess, there are 
hectic rigors and recurring night sweats, persistent and profuse 
vomiting, the pain becomes sharp and localized, the temperature 
rises, and exhaustion and emaciation are rapidly developed. 
Hepatic abscesses may be discharged in a variety of ways : 
through the abdominal wall, into the peritoneal cavity, into the 
stomach, intestines, etc. (Loomis). 

Physical Signs. — -If the abscess is large, inspection will show 
a bulging of the right hypochondriac region. By palpation the 
liver is enlarged and has an uneven feel. The pain is increased 
by pressure, and localized. Fluctuation may be present. By 
percussion the area of hepatic dullness is increased. 

Prognosis. — The majority of abscesses of the liver terminate 
fatally. 

Treatment. — When pus has formed, and the locality of the 
abscess can be determined, aspiration should be performed. 
The abscess should be opened as soon as possible (Loomis). 

HERPES, 

Is an acute, non-contagious affection, characterized by the 
development of one or more groups of vesicles, and accompanied 
by burning heat, pain or itching, which runs its course in from 
one to three or four weeks, and may recur (Anderson). 



246 A COMPENDIUM OF PRACTICAL MEDICINE. 

Varieties. — 1. Herpes facialis. 2. Herpes prseputialis. 3. 
Herpes iris. 4. Herpes zoster, or shingles. 

Herpes facialis is the most frequent, and the parts most 
commonly attacked are the red portions of the lips, but any part 
of the face, or even the mucous membrane of the nose, palate or 
tongue may be involved. At first there is redness and burning 
heat, then little elevations appear, which soon develop into vesi- 
cles, often of large size; these at first are filled with clear serum, 
which soon becomes opaque or even purulent. 

Causes. — In many cases it is consequent upon catching cold, 
or upon digestive derangement. It is also, a very frequent ac- 
companiment of febrile affections, especially pneumonia in which 
disease its occurrence may even aid the diagnosis. Herpes 
jprasputialis is most often met with on the prep ace, but may be 
seated upon the glans, or even upon the skin, and in women 
upon the labia. The vesicles very soon rupture, so that often by 
the time attention is directed to the part by the burning heat, 
only a group of little excoriations is to be seen. These are 
irritated by the secretion and may be mistaken for soft chancres, 
especially as the eruption sometimes follows connection. This 
variety of herpes is often very troublesome, and may recur half 
dozen times in the course of a year. It is said to be more apt to 
occur in those who have suffered from venereal diseases. Herpes 
iris is rare, and is met with in young persons. It occurs in spring 
and autumn, and attacks most usually the dorsum of the hands 
and feet, and the fingers and toes. All the colors of the rain- 
bow may usually be observed at one time or another in the course 
of the disease. Herpes zoster, or Shingles, is the most serious of 
the forms of herpes, and differs from the others in that the erup- 
tion follows the course of certain cutaneous nerves. In its most 
typical form, it affects one side of the chest. It may attack other 
parts of the trunk as well as the extremeties, the head and neck, 
where it also follows the course of a nerve. Neuralgic pains 
usually accompany it (Anderson). 

Treatment. — In all varieties of herpes the part must be 
dusted with some soothing powder. Arsenic is the best internal 
remedy. The diet should be light, and saline aperients should 



HERPES HICCOUGH. 247 

be used. Dr. Meredith recommends the painting of the part 
with oil of peppermint to relieve the pain (Anderson.) 

PRESCRIPTIONS FOR HERPES. 

J& Zinci oxidi.. gij". 

Glycerine gij . 

Liq. plumbi subacetat dil ^iss. 

Liq. calcis ^vi.-viij . — M. 

Ft. lotio. 
Sig. : Apply locally. — Tilbury Fox. 

j& Hydrargyri chloridi mitis gj. 

Unguenti simplicis §j. — M. 

Ft. ungt. 
Sig. : Apply locally. — Pareira. 

HICCOUGH. 

Treatment, — Apomorphia cured a case of persistent hiccough 
when hypodermic injections of morphia and atropia had failed. 
Camphor has been recommended in hiccough. Chloroform, com- 
bined with opium, is said to control persistent hiccough (Ringer). 
A hypodermic injection of morphia often arrests persistent hic- 
cough. Cases of obstinate and even dangerous hiccough are 
reported which have been immediately cured by drinking an in- 
fusion made with a teaspoonful of mustard steeped in four 
ounces of boiling water for twenty minutes, and then strained 
(Ringer). 

PRESCRIPTIONS FOR HICCOUGH. 

Jfc Pilocarpine muriatis gr. ^. 

A qu se destillatse IHx . — M . 

Sig.: Inject hypodermically. — Ortille. 

Jfc Pulveris sinapis 5j- 

Aqure bullientis , 5 iv. — M. 

Ft. infusum. 
Sig.: Take at one draught. — Ringer. 

jfc Apomorphise muriatis gr. -fa. 

Aquae destillate ZTCx. — M. 

Sig.: Inject hypodermically. — Ringer. 



248 A COMPENDIUM OF PRACTICAL MEDICINE. 

HYDROCEPHALUS. 

Is dropsy of the brain. It may be congenital or acquired. 
The congenital consists in an excess of the cerebro- spinal fluid, 
lying either externally to the brain, or more frequently in its in- 
terior (Smith). 

Causes. — Syphilis may be a cause of congenital hydrocepha- 
lus, but in many cases the cause is unknown. It may be associ- 
ated with spina bifida (Smith, J. L.) 

Symptoms. — While the volume of the head increases, emaci- 
ation of the neck, trunk and limbs is common. In the last 
stages, there is more or less vomiting. As the liquid increases, 
the child becomes drowsy and takes no notice of objects, and 
finally convulsions occur (J. L. Smith). 

Prognosis. — Unfavorable. 

Treatment. — Digitalis, squills, acetate of potassium, and 
iodide of potassium are the remedies for this affection. One or 
two grains of iodide of potassium may be given every two hours 
to an infant of three months. A close-fitting cap may partially 
prevent the expansion of the head. Tapping frequently gives 
temporary relief, and should be performed with a very small 
trocar, which should be introduced in the coronal suture about 
an inch external to the anterior fontanel (J. L. Smith). 

Causes of Acquired Hydrocephalus. — Meningeal inflammations, 
tumors or other causes which obstruct the venous circulation, 
prolonged passive congestion, affections of an exhausting nature, 
and protracted infantile diarrhoea. 

Symptoms. — The child has headache, is irritable, is delirious, 
drowsy, and its head seems too heavy for its body and is buried 
in the pillow (J. L. Smith). 

Prognosis. — Unfavorable. 

Treatment for the Acquired. — Cold applications to the head. 
The bowels should be kept open, and derivatives should be 
applied to the feet and back of the neck. The acetate and iodide 
of potassium may be given, and vesication should be produced 
behind the ears (J. L. Smith). 



HYDROCEPHALUS HYDROTHORAX. 249 

PRESCRIPTIONS FOR HYDROCEPHALUS. 

jfc Collodii cum cantharides ^iv. 

Sig. : Paint the back of neck every few days. ' — Hartshorne. 

# Olei tiglii IHij. 

Mucil acacia? ^ij. 

Aquae destillatse §j . — M. 

Sig. : The fourth part every four hours. (Said to remove fluid 
from the ventricles). — Dungleson. 

jfc Potassii iodidi 3ss-j. 

Syrupi aurantii cort ,5j. 

Aquae ad 3iv. — M. 

Sig.: A teaspoonful every two hours to an infant of six months. 

—J. L. Smith. 

HYDROTHORAX. 

A dropsy having its seat in the pleural cavity is called hy- 
drothorax, or water on the chest. It differs from pleurisy in the 
character of the fluid and in the state of the pleura. In pleurisy 
the effusion is an inflammatory exudation, and the pleura is the 
seat of an inflammation; in hydrothorax the fluid transudes, and 
the pleura is unaffected (Bartholow). 

Causes. — It is due to an organic disease of the liver, heart, 
or kidneys, and the serum collects in both pleural sacs. An ef- 
fusion caused by an inflammation of the pleura is nearly always 
one sided. It may occur in any exhausting disease which causes 
general hydraemia, and is usually associated with dropsies in other 
parts of the body. Chronic malarial poisoning and Bright' s dis- 
ease may cause it. 

Symptoms. — There is no fever nor pain in the side. The 
first symptom referable to the thorax is increasing difficulty of 
breathing, until the patient reaches a condition of extreme dis- 
tress; the lips become livid, the finger ends blue, and the respira- 
tion gasping. He is unable to lie down, and can speak with dif- 
ficulty. There may be a short dry cough- The physical signs 
of hydrothorax is fluid in both pleural cavities, which is not at- 
tended by friction sounds or vocal fremitus (Loomis). 

Treatment. — If there is much effusion, delay is unsafe and 
thoracentesis should be promptly performed. As serum will 



250 A COMPENDIUM OF PRACTICAL MEDICINE. 

flow through a flue capillary needle, but little pain and no dan- 
ger attend the operation of aspiration. Such remedies as hydra - 
gogue cathartics, and diuretics are useful. Elaterium is the best. 
Digitalis should be given (Bartholow andLoomis). 

HYPOCHONDRIASIS. 

Is a disorder of the mind, but the mental aberration is not 
regarded as amounting to insanity, and patients with this affec- 
tion are not proper subjects for treatment at lunatic asylums. 
Cases are frequent and they claim the services of the general 
practitioner. 

The characteristic feature of the affection is a morbid 
apprehension of either the existence of, or a liability to some 
serious disease (Flint). 

Forms. — In its mildest form it consists of a feeling of ex- 
treme delicacy of constitution. Existing in this form, it leads to 
an anxiety concerning health and over -precautions for its preser- 
vation. In the severest form of the affection, patients suffer 
from the conviction that they have an incurable malady. The 
hypochondriac is the victim of a delusion with respect to his 
condition. Disease of the heart, consumption, cancer, syphilis, 
tapeworm, softening of the brain and diabetes are among the 
diseases which in different cases are supposed to exist. Hypo- 
chondriacs frequently consult many physicians in succession, but 
no one is able to convince him of his delusion. Persons of edu- 
cation and strong mental powers are as liable to the affection as 
those who are ignorant and of feeble mind. Some patients 
imagine they have one particular disease, others imagine they 
have various diseases, or fix upon one for a time and then another 
(Flint). 

Causes. — Are both physical and mental. Some persons are 
constitutionally liable to morbid apprehensions in this direction. 
Whenever they are ill with any affection, their mental constitu- 
tion leads to a sense of danger, and to despondency as regards 
recovery. This state of mind exerts a depressing influence which 
may interfere seriously with the favorable progress of disease. 
Masturbation, excessive sexual indulgence and the intemperate 
use of alcoholic stimulants are causative. 



HYPOCHONDRIASIS. 251 

The reading of legitimate medical works is to be mentioned 
among the causes of hypochondriasis. Want of mental occupa- 
tion may cause it; and persons who have relinquished active pur- 
suits often become hypochondriacs. Misfortunes are causative. 

The physical disorders are angemia, neurasthenia and dys- 
pepsia. 

Treatment. — Remove the supposed causes if possible. Over- 
exertion, mental or physical, is to be avoided. Sexual abuses, 
intemperance and any violation of the laws of health are to be 
inquired into and reformed. Anseraia and dyspeptic ailments 
claim treatment. Remedies have a useful moral effect within 
certain limits. Patients often crave remedies. The mental 
treatment is the most important. It is not wise to attempt to 
dispel the delusions by ridicule or indifference, but by argument 
and assurances. The patient's attention should be diverted from 
himself. Change of scene and new associations should be ad- 
vised. 

PRESCRIPTIONS FOR HYPOCHONDRIASIS. 

R Liq. potassii arsenitis XHxL. 

Tinct. opii 3J. 

Aquae menthae pip ad ^iiss. — M. 

Sig. : A teaspoonful three times daily. (In aged with gloomy 
fancies). — Lemare-Picquot. 

R Morphia:- sulphatis gr. i-ij. 

Sacchari lactis gr. x. — M. 

In pulv. no. xii. div 

Sig.: A powder three times daily for at least two months. 

— Hammond. 

R Mist asafoetidae %iv. 

Sig.: One to two teaspoonfuls three or four times daily. 

— Bartholow. 

R Potassii bromidi ^ss. 

In pulv. no. xii. div. 
Sig.: A powder in cold water three times daily. — Ringer. 

R Auri chloridi gr. i-iss. 

Ext. gentianae gr. xv. — M. 

Ft. massa et in pil. no. xxx. div. 
Sig.: One pill thrice daily. — Bartholow. 



252 A COMPENDIUM OF PRACTICAL MEDICINE. 

HYSTERIA. 

Is a functional nervous trouble, characterized by various 
motor, sensory and intellectual disturbances (Bartholow). 

Causes. — Hysteria is almost exclusively confined to women. 
It is most frequent between the ages of fifteen and twenty- five. 
If the neurotic type of constitution is inherited, in one genera- 
tion it may assume the shape of hysteria; in the next epilepsy; 
and in the third insanity. It is not due to derangement of the 
uterus and ovaries, but to a peculiar morbid state of the nervous 
system. This peculiar state of the nervous system may be 
acquired by faults of early training, by a lack of personal discip- 
line; by mortification or chagrin. Anaemia and an impoverished 
condition of the blood may cause hysteria. The disturbances 
may be in the digestive system, in the circulatory, in the sexual, 
or in the nervous. It is most liable to occur in members of 
families in which epilepsy, chorea, catalepsy and insanity have 
occurred. Fright, anger, jealousy, grief and disappointment 
predispose to its development. Among savage nations and hard 
working women it is unknown or rare. It is apparently con- 
tagious (Bartholow and Loomis). 

Symptoms. — The first symptoms are usually trivial — mere 
irritability of disposition, rapid changes of feeling, noisy transi- 
tions of sadness and joy, tears and laughter. There are quick 
alternations of cold and heat, that are purely subjective; numb- 
ness, tingling, suffocative feelings, pain around the heart, palpi- 
tations, quick breathing, a sense of fullness of the stomach, eruc- 
tations of gas, and the rising of a globe to the larynx (globus 
hystericus), producing a sensation of choking, restlessness, the 
whole ending, it may be, in prolonged laughter, but more usually 
in crying, and in a profuse urinary discharge, the urine being 
pale and watery. In the more severe attacks, patients laugh and 
cry, choke, gasp for breath, sob and cough; the jaws are fixed, 
the face retracted, the teeth grinding together, the hands clinched, 
the limbs drawn up and rigid. In some cases there are tonic and 
clonic convulsions. There is no loss of consciousness. In some 
cases there is a death -like pallor of the face and half- closed 
eyes. The attack is more apt to occur during the menstrual 



HYSTERIA. 253 

period. Headache is the most common form of pain. Colics are 
frequent. Paralysis is sometimes a symptom of hysteria. Gas- 
tralgia, irritable bladder and spinal irritation are frequent symp- 
toms (Bartholow). During their hysterical paroxysms, they 
always want an audience; they crave attention and sympathy. 
Pain in the skull, as if a nail were being driven into the head, or 
a kettle were simmering on top of it, called by the ancient phy- 
sicians clavus . hystericus, is by many regarecl as pathognomonic. 
The whole or only a part of the cutaneous surface may be 
hyperaesthetic or anaesthetic. There is often pain in the joints. 

Differential Diagnosis. — Hysteria may be mistaken for epil- 
epsy, hypochondria and neuralgia. It is distinguished from 
epilepsy by its slow onset, by incomplete coma, a normal pupil, 
sobbing and crying. The tongue is not bitten in hysteria. In 
hypochondria the patient is always morose; there are not those 
variations in temper that are so characteristic of hysteria. 
Hypochondria is rare before the thirtieth year, is more common 
in men than in women. The two diseases may be conjoined 
(Loomis). Neuralgia, if of hysterical origin, ceases when the 
patient's attention is diverted. 

Treatment. — Moral and hygienic measures are most impor- 
tant. Self-control should be instilled into the mind. Early 
hours, substantial food, and plain clothing should be insisted 
upon, while society, the follies of dress and fashion, and dainties 
should be prohibited. The proper books should be selected for 
young ladies. Sexual abuses have an injurious effect on the ner- 
vous system. For anaemia, iron, arsenic, and strychnine should 
be given. For the seizure, a little fluid extract of valerian, or a 
few drops of Hoffman's anodyne repeated every few minutes will 
terminate the attack. In the convulsive form, inhalations of 
amyl nitrite or of ethyl bromide may be practiced. The mi- 
graine may be cured by use of mix vomica, arsenic, aconitine. 
and galvanism. Hysterical aphonia and dysphagia may some- 
times be cured instantly by faradic applications- Anaesthesia is 
best treated by the electric brush. The various forms of hyster- 
ical paralysis require faradic applications. Mitchell has devised 
a plan of treatment for bed fast hysterical subjects which seems 
very successful. It consists in the combined use of massage, 



254 A COMPENDIUM OF PRACTICAL MEDICINE. 

faradization, and forced feeding. Massage consists in friction, 
kneading and tapping of all the muscles, in passive motion to all 
the joints. The diet consists at first of milk only. No exercise 
is allowed, but all movements are made for the patient. The 
patient is separated from all her former associations and the su- 
perabundant sympathy of home. She is placed in bed in charge 
of a nurse, and not permitted to move; the desire for action 
grows out of the utterly monotonous idleness (Bartholow). 

PRESCRIPTIONS FOR HYSTERIA. 

R Tinct. opii 3j. 

Tinct. nucis vomicae gij. — M. 

Sig. : Three drops in water thrice daily. (For weight on the 
head, flushings, hot and cold perspiration). — Ringer. 

R Paraldehyde rrtxxx. 

Syrupi simplicis gss. 

Aquae menthae pip. §j. — M. 

Ft. haustus. 
Sig.: To be taken at a draught. (To produce sleep). 

R Spiritus aetheis compositi 

Tinct. Valerianae amnion aa...^j. — M. 

Sig. : A teaspoonful in water every fifteen minutes until relieved. 

— Bartholow. 

R Apomorphiae muriatis gr. j . 

Syrupi simplicis 3iv. 

Aquae ad 3x. — M. 

Sig. A teaspoonful as required. Repeat in a few hours if 
necessary. — Ringer. 

R Ext. salicis nigri. 

Elixir simplicis aa f j . — M. 

Sig.: A teaspoonful three times daily. — Hutchinson. 

R Ferri citratis 31J. 

Syr. simplicis ^ss. 

Aquae aurantii flor ad Svi. — M. 

Sig. : A tablespoonful three times daily. — Hartshorn e. 

R Ammonii bromidi 3ij. 

Spiritus ammoniae aromat 5j. 

Aquae !iv. — M. 

Sig. : A dessertspoonful thrice daily. — Hartshorne. 



HYSTERIA HEAT STROKE. 255 

Jfc Liquoris potassii arsenitis £ss. 

Sig. : Three to five drops thrice daily after meals. — Bartholow. 

JJr Extracti conii fluidi. 

Ext. hyoscyami flld aa JTtvij. 

Chloral hydratis,. gr. x. 

Aquae ad §j. — M. 

Ft. haustus. 
Sig.: To be taken as a single dose and repeated as required. 

— Madigan. 

HEAT STROKE. 

Called also sunstroke, insolation, or heat fever, is the com- 
plex of symptoms occurring in persons exposed to extreme heat 
under unfavorable circumstances (Loomis). 

Causes. — It is due to the influence of excessive heat — natural 
or artificial. The habitual consumption of spirits, beer, and al- 
coholic beverages, and excessive fatigue and overcrowding pre- 
dispose to attacks. Workmen, soldiers on the march, cab- driv- 
ers, or brain workers are more liable to be overcome by the heat. 
Hot, wet, muggy days — our August dog-days — are the most fa- 
vorable for its occurrence. In Dakota men can work all day ex- 
posed to the sun when the temperature of the air is at least 140° 
to 160° while in New York on a cloudy, wet day in August, 
with the temperature at only 93 degrees, large numbers of men 
and animals are prostrated (Loomis). 

Symptoms. — The majority of the cases occur in the middle of 
the day. In mild cases the patient suddenly becomes exhausted, 
and probably faints, or becomes semi- comatose. He is utterly 
prostrated; the skin is pale, cold and moist; the pulse is quick 
and feeble, and all kinds of symptoms are referred to the head — 
floating:, swimming, vertigo, fullness and neuralgic pain. These 
cases may recover or terminate fatally from heart failure. In a 
severer form, a man may be struck down suddenly, unconscious- 
ness suddenly follows; the skin is cold, the pulse is feeble, and 
death may result from heart failure. In another form called 
thermic fever, the temperature rises to 108° or 110° F. or 
even higher. This is due to the influence of heat on the nerve 
centre. It often occurs at night and in those who are dissipated 



256 A COMPENDIUM OF PRACTICAL MEDICINE. 

or worn out. There is great restlessness, thirst, dyspnoea, and 
the skin is burning hot. Delirium and epileptiform convulsions 
are common, and finally the patient passes into a complete coma, 
with sterterous breathing (Loomis). 

Differential Diagnosis. — It may be mistaken for acute menin- 
gitis. In the latter the projectile vomiting, the boat belly, the 
pale face, and the tense, hard, wiry pulse are in striking contrast 
to the symptoms of sun-stroke. Acute alcoholismus maybe con- 
founded with sun -stroke, but the history of the case will decide 
(Loomis). 

Prognosis. — Except in mild cases, is very bad; nearly one- 
half die (Loomis). 

Treatment. — The patient must have absolute rest and plenty 
of cool, fresh air. Stimulants are often necessary. In most 
cases the cold water treatment is the best. The patient should 
be taken to the nearest pump, stream or water-tank and im- 
mersed for a considerable time, or a stream of cold water should 
be poured over the head, neck and back. In the thermic fever 
form, ice water should be applied to the surface, the bowels 
should be moved by a saline and morphine and quinine given. 
The inhalation of ether or chloroform is often of service in this 
form (Loomis). 

HECTIC FEVER. 

Is a fever of irritation. It accompanies many chronic dis- 
eases in which destruction of tissues occur, especially phthisis. 
It is a form of remittent fever, consisting of an exacerbation, 
once or sometimes twice a day, depending on suppuration in 
many cases (DaCosta). 

Symptoms. — One of the first symptoms is a slight increasing 
frequency of pulse, and a small degree of heat of skin, generally 
toward evening. The heat is especially felt in the palms of the 
hands and the soles of the feet. The fever reaches its height 
about midnight and terminates by a profuse perspiration toward 
morning. The respiration is quick and short. The appearance 
of the face is characteristic, there being a circumscribed blush in 
the centre, known as the "hectic flush." The patient loses flesh 
rapidly. The pulse is above 80 and is soft. The temperature 



HECTIC FEVER HIVES HOARSENESS. 257 

as a rule varies from 99° to 101° F. Hectic fever is always 
symptomatic of some particular disease, of profuse discharge, as 
of pus or blood, or of an abscess of the brain, lungs or liver, and 
is in part due to the entrance of septic products into the blood, 
as in septicaemia. 

Treatment. — Kemove the diseased part, or let out the pus. 
The diet should consist of animal and farinaceous food, eggs, 
macaroni, milk, wine, beer, etc. Quinine, sulphuric acid and 
iron are the medicines generally indicated. For diarrhoea, aro- 
matic sulphuric acid, opium, and chalk mixture are efficient. 

Night Sweats. — Sponge the surface with cold water, or 
alum and water. Fifteen drops of aromatic sulphuric acid 
three times daily, or an sV gr. of sulphate of atropia combined 
or not with oxide of zinc, two or three grains, may be given at 
bedtime (Compend). 

RRESCRIPTIONS FOR HECTIC FEVER. 

R Quinise sulphatis 5j. 

In pulv. no. xii. div 

Sig.: A powder in water three times daily. — Phillips. 

R Syr. calcis lactophosphat Siv. 

Sig. : A teaspoonful three times daily. — Beneke. 

R Tinet. digitalis giij. 

Tinct. ferri chloridi 3v. — M. 

Sig.: Fifteen drops in water three times daily. — Bartholow. 

R Anti pyrin gr. xL. 

Aqua? oviij.— M. 

Sig.: Two tablespoonfuls, followed by one tablespoonful every 
hour till temperature is normal. — Pribram. 

HIVES. (See Urticaria). 

HOARSENESS. 

Treatment. — Chronic bronchitis and hoarseness produced by 
singing and by simple acute catarrh are relieved by ten minim 
doses of dilute nitric acid. Aphonia due to fatigue of the vocal 
cords and hysterical aphonia may be removed very speedily by a 



258 A COMPENDIUM OF PEACTICAL MEDICINE. 

morning and evening dose, (rio-To of a grain) of atropine (Bar- 
tholow). 

Ten grains of alum to the ounce of water is used in the 
form of spray for chronic coughs and hoarseness (Ringer). 

Dr. Carson finds that a piece of borax the size of a pea, dis- 
solved in the mouth, acts magically in restoring the voice in 
-cases of sudden hoarseness brought on by a cold, and frequently 
for an hour or so, it renders the voice "silvery and clear." 
Borax is useful in hoarseness common among clergymen and 
singers. In chronic inflammation of the throat, a few applica- 
tions of glycerine of tannin brace up the tissues and lessen or 
remove the hoarseness. The ipecac (wine) spray is useful in 
hoarseness from congestion of the vocal cords. Where the 
hoarseness has lasted a few clays only, or one or two weeks, the 
spray often speedily cures. At the commencement of a feverish 
cold, a Turkish bath will cut the attack short, remove the aching 
pains, and relieve or cure the hoarseness at once (Ringer). 

HORDEOLUM. (See Stye.) 
HOUSEMAID'S KNEE. 

Is an inflammation of the bursa of the knee, between the 
patella and skin, which is common to housemaids, from kneeling. 
It is usually chronic, but may be acute. It causes great pain and 
swelling, the swelling being superficial and in front of the 
patella. An enlargement of the bursa at the elbow is called 
"miner's elbow." Bryant has seen the bursa enlarge over the 
acromian process in men who carry timber; over the tuberosity 
of the ischium in weavers; over the external malleolus in tailors; 
over the malleoli, and also the instep, from pressure of a boot; 
over the ball of the great toe in cases of bunion, etc. 

Treatment. — Rest, leeches, fomentations and purgatives; if 
these do not bring relief, an incision should be made into the 
swelling. After evacuating the contents of the sac, a small 
quantity of equal parts of tincture of iodine and alcohol should 
be injected into it. Dr. Lewis recommends injections of carbolic 
acid. It may be tapped (Bryant and others). 



HYDROCELE HEMATOCELE. 259 

HYDROCELE. 

Is an accumulation of scrum in the tunica vaginalis testis, 
and it may be of the spermatic cord. The swelling of hydrocele 
first shows itself at the lower part of the scrotum and gradually 
rises till it arrives at the abdominal ring. It is of a j)yriforni 
shape. Usually it is attended with pain. Commonly there is no 
discoloration of the scrotum. In hydrocele the testicle is two- 
thircls of the way down the tumor at the posterior part, but it 
may sometimes be found in front, or at the bottom. The diag- 
nostic signs are a sense of fluctuation, transparency, lightness and 
freedom from pain. In very old cases the transparency may be 
absent. 

Congenital Hydrocele. — When the tunica vaginalis preserves 
its communication with the abdomen, and then becomes filled 
with serum, it is called congenital hydrocele. On being raised 
and compressed the fluid is slowly squeezed into the abdomen, 
and slowly trickles dowm again afterward. 

Treatment. — Is either palliative or curative. The evacua- 
tion of the serum constitutes the palliative treatment. This is 
accomplished by a puncture with a small trocar and canula. 
Palliative treatment is sufficient for children, but rarely so in the 
case of adults. The radical cure is performed by injecting into 
the sac a fluid composed of one drachm of tincture of iodine, and 
one or two drachms of water, after first having withdrawn all 
the serum from the sac. When the inflammation subsides the 
fluid generally secretes no longer. Dr. Lewis recommends injec- 
tions of a half a drachm to a drachm of pure carbolic acid lique- 
fied with water or glycerine into the sac. In obstinate cases, a 
free incision into the tunica vaginalis, and the filling of the 
cavity with carbolic or iodoform gauze to make it fill up by 
granulation, is also to be recommended (Bryant). 

HEMATOCELE. 

Is an extravasation of blood into the tunica vaginalis. It 
may occur as the result of a blow, strain, or the tapping of a 
hydrocele, or it may arise without any assignable cause. 



260 A COMPENDIUM OF PRACTICAL MEDICINE. 

There is swelling of the part, which comes on immediately, 
or soon after the receipt of the injury. It resembles hydrocele 
as regards shape. At first the tumor is soft, and fluctuation may 
be detected, but when the blood coagulates it resembles in its 
character a solid growth. There is testicular pain on pressure. 
It is a non- transparent tumor, smooth and tense (Bryant). 

Treatment. — In a recent case the first indications are to 
arrest the flow of blood and relieve pain. The recumbent posi- 
tion, with testicles raised, is necessary; the ice-bag and cold 
lotions must be applied. If the blood remains fluid for a long 
time, tapping may be performed. In chronic cases where there 
are signs of suppuration, a free incision should be made into the 
vaginal sac, and the cysts and clots turned out. Then will 
follow the usual treatment to promote healing by granulation 
(Bryant). 

HYPERIDROSIS, (See Ephidrosis.) 
H^EMIDROSIS. 

Is an affection characterized by a flow of blood from the skin 
independent of any pre-existing lesion as a wound, abrasion or 
ulcer. The term literally signifies bloody sweat. Discharges of 
blood from wounds, abrasions and ulcers of the skin in connec- 
tion with menstruation, are quite common; but cases in which 
the flow takes place without any lesions are exceedingly rare. 

Causes. — The disease occurs most frequently in females, and 
in connection with amenorrhcea or defective menstruation, being 
in fact, a species of vicarious menstruation. It has been known 
to occur in infants and in adult males. It has been supposed 
that the hemorrhage is due to debility and deterioration of the 
blood. 

Treatment. — When the disease occurs in females in connec- 
tion with the anomalies of menstruation, these must be corrected 
by the usual means. The abstraction of blood, local and gen- 
eral, is likely to prove serviceable and to stop the discharge. If 
the hemorrhage seems to be due to debility, a nourishing diet,, 
stimulants and tonics are indicated (Anderson). 



HODGKIJs's DISEASE — HYMEN HYPOSPADIAS. 261 

HODGKIN'S DISEASE. (See Lymphadenoina). 
HYMEN. (Imperforate and Eigicl). 

Imperforate hymen is a condition to be recognized and not 
confused with adherent labia. The hymen is more deeply 
placed and nearer the orifice of the vagina. When imperforate, it 
causes retention of the menses, the accumulation of the secre- 
tions, and a pelvic tumor usually accompanied by periodic pain 
and constitutional disturbance (Bryant). 

Treatment. — Division of the imperforate membrane, or its 
complete excision to allow of the free escape of the secretions 
which are usually black, is the proper treatment (Bryant). A 
rigid hymen is occasionally an impediment to coitus in women 
who marry late in life; and Thomas Bryant has been called upon 
on one occasion to divide the hymen of a lady about thirty who 
had been married for some months and had never had complete 
connection. 

HYPOSPADIAS. 

Is a malformation in which, the canal of the urethra, instead 
of opening at the apex of the glans, terminates at the base or 
beneath the penis. It is a congenital deformity and is due to an 
arrest of development of a portion of the lower wall of the 
urethra. Hypospadias is much more common than epispadias. 
In examining sixty thousand conscripts, Marchal did not find a 
a single case of epispadias ; but among three thousand conscripts 
ten cases of hypospadias were found. Hypospadias may occur at 
any point in front of the membranous urethra, but is more fre- 
quently confined to the glans penis. The only disturbances 
caused by hypospadias are functional. The patient may not be 
able to pass water without wetting himself, and if the opening is 
too low in the canal he may be impotent (Keyes). 

Treatment. — Simple hypospadias rarely calls for surgical in- 
terference, and hypospadias of the glans penis is unimportant. 
The operations which have been performed for its relief are not 
very encouraging in their results (Keyes). 



262 A COMPENDIUM OF PRACTICAL MEDICINE. 

HEAD INJURIES. 

Must not be neglected, however trivial. They may be fol- 
lowed by erysipelas, inflammation and suppuration. 

Treatment, — They should be sutured at once with edges 
carefully coapted. Care should be taken to wash away all for- 
eign bodies and clots with bichloride of mercury solution and a 
syringe. No part of the scalp however torn should be cut away. 
The patient should be confined to bed, or to the house, purged 
and put on a milk diet. The hemorrhage from small vessels is 
usually controlled by closing the wound and using pressure; 
larger vessels must be tied (Bryant). 

Caution. — Every scalp wound should be carefully examined 
with the finger and probe, to ascertain whether or not fracture 
of the skull exists. If suppuration occurs as indicated by rigors, 
chills, dry tongue, with increase of swelling and throbbing pain, 
the adhesions must be separated and pus let out (Bryant). 

HORNS. 

While horns occur normally on the heads of many of the 
lower animals, they are rarely met with in man. 

Causes. — We know very little with regard to the causes 
which induce them. It is probable that in many cases at least 
local irritation has something to do with their production. 

Situation. — They are most commonly met with on the head 
and face, although any part may be implicated. They are more 
common in females, and are usually seen in persons who have 
passed middle life. Usually they are solitary, but occasionally 
multiple. Botge has reported the case of a girl aged 19 who 
had a horn close to the navel about six inches in length, while 
on the right labium there was one but a trifle shorter. The most 
remarkable case is that of a Mexican porter who had a horn on 
the upper and lateral part of his head which was fourteen inches 
in circumference around its shaft and divided above that point 
into three branches. Horns spring from the mucous layer of the 
epidermis and are composed entirely of epidermic cells. 

Color. — Horns are usually grayish, yelloAvish or brownish in 
color. They grow slowly, years often elapsing before they attain 



HERNIA. 263 

their full size. The horns themselves are quite insensitive, but 
by pressure may give rise to pain. Sometimes the skin at their 
base inflames and suppurates and they fall off ; but they are apt 
to recur (Anderson). 

Treatment. — Consists in tearing out the horn after softening 
it with poultices, but in order to prevent its return, it is desira- 
ble to cut out the piece of skin from which it grows, or to caut- 
erize the bases freely with chloride of zinc or caustic potash 
(Anderson). 

HERNIA. 

Called also rupture, is the protrusion of any viscus from its 
natural or containing cavity. Rupture is the wrong term, as 
there is no rupture of the peritoneum; it simply forms a sac or 
one of the coverings. It includes hernige of the brain, testicle, 
lung, and mostly of the alimentary canal. 

Reasons for Studying Hernia. — 1. Because of its frequency; 
one person in eight is affected with hernia. 2. Because of the 
effects of the presence of hernia: (a) the individual cannot enter 
the army or navy; (b) he must pay a higher life insurance; (c) 
he cannot enjoy the privileges of charity; (d) he is deprived of 
many pleasures. 

Classification. — There are ten varieties, five above the linea 
ilio pectinea, and five below that line. The five above are called 
abdominal and are: 1. Diaphragmatic. 2. Ventral. 3. Um- 
bilical. 4. Inguinal. 5. Femoral. The five below are called 
pelvic and cere: 1. Obturator. 2. Ischiatic. 3. Vaginal. 4. 
Pudendal. 5. Perineal. 

Tlie Component Parts of a Hernia are: 1. Coverings. 2. 
Sac. 3. Contents. The coverings of a hernia vary according to 
the variety and situation. The skin, fascia, muscle, subperitoneal 
tissue, and peritoneum cover all herniae. The sac always consists 
of peritoneum. It undergoes changes and may be thin or very 
thick. The sac is divided into different parts: 1. Mouth. 2. 
Neck. 3. Body. 4. Fundus. The mouth is the opening be- 
tween the cavity and the sac. The neck is the narrow con- 
stricted portion close to the mouth. The body is the part below 
the neck. The fundus is the largest portion of the body. Three 



264 A COMPENDIUM OF PRACTICAL MEDICINE. 

kinds of adhesions exist: 1. Adhesions of the guts to each other. 
2. Adhesions of the guts to the sac. 3. Adhesions of the sac to 
the external coverings. The contents of the sac may be the ileum, 
colon, sigmoid flexure, or caecum. Every viscus except the pan- 
creas has been found in the sac. Fluid is found in the sac, from 
one ounce to a pint. The fluid is secreted from the sac, and is 
generally clear, but is bloody in inflamed hernia. 

A hernia is named by adding " ocele " to the name of the 
body contained, or may be named according to situation. 

Causes. — 1. Predisposing. 2. Exciting. — Predisposing 
causes are : hereditary conformation of the parts, 34 per cent, are 
of these, 12 per cent, of which are in the first year; structural 
defects, as large inguinal rings, lax peritoneum, low attachment 
of the mesentary, wounds and abscesses and sudden emaciation 
after great corpulence. 

Exciting Causes are : forced action of the diaphragmatic 
and abdominal muscles, as in straining at stool, lifting heavy 
weights, vomiting, crying, coughing in pneumonia or bronchitis; 
distension of the alimentary canal; certain forms of violent ex- 
ercise, as horse-back riding without stirrups; sailors pulling at 
ropes, and persons riding bicycles. 

Signs and Symptoms. — By inspection, we observe : a tumor 
at a hernial opening; a tumor increasing and diminishing in size 
and weight in the upright and recumbent position; and a tumor 
with healthy skin over it. 

By examination, we find that the tumor is reduced by taxis 
and returns on coughing; that the tumor has an impulse on 
coughing (unless strangulated); that the tumor may be hard, re- 
sisting, lobulated as in epiplocele, or soft, elastic and smooth if 
an enterocele. 

By inquiry, we learn that the tumor suddenly appeared 
from above and never from below; that the tumor is not painful, 
but is uncomfortable; that the tumor is often associated with 
intestinal disturbance. 

Diagnosis. — Make the patient stand before you with his back 
to a table and lean backwards. If in bed make him lie with a 
pillow under his nates. Note if the tumor is connected with the 
ring. Place a finger in the ring, through the scrotum, and ask 



HERNIA. 265 

patient to cough; you will feel an impulse on the end of your 
finger. In women, feel for the spine of the pubes and pass your 
linger up a little. In femoral hernia, feel for pulsation of the 
femoral artery and ask the patient to cough. Inquire into the 
history of the patient. See if the tumor is fixed or movable. 
Percuss the tumor and if intestinal it will be tympanitic, if 
epiplocele dull, if solid, flat. Hernia is not transparent. A hy- 
drocele will transmit light unless it contains blood or gut and 
then it is opaque. In hernia only there will be an impulse on 
coughing. 

Treatment of Ordinary Reducible Hernia. — Place the hernia 
back into its proper cavity and prevent its return by a truss. 
A truss should be used and the following points observed : 1. 
Notice the spring — have it not too weak or not too strong; 2. 
Notice the pad, it should be covered with kid to prevent irrita- 
tion to the integument; 3. Use a rubber truss in bathing. Put 
the truss on while the patient is lying down, as in going to bed 
at night and rising in the morning. Hernia should be kept back 
all the time, and the patient should never go without a truss. 
Prof. Dennis has never seen a hernia which he could not keep 
back with a truss. You should never guarantee a cure by a 
truss, but the younger the patient, the more likely is he to be 
cured by the use of a truss. The neck of the sac contracts and 
the mouth puckers up. There is danger in wearing a truss 
which does not fit properly. Never allow the hernia to be 
pressed. Never allow constipation to exist in hernia. 

Pathological Conditions. — There are certain pathological condi- 
tions which distinguish hernige, as 1. Irreducible; 2. Incarcerated: 
3, Inflamed; 4, Strangulated. 

An Irreducible Hernia is caused by adhesions, by the nature 
of the protrusion, by the shape of the hernia (hour-glass), or by 
contraction of the ring, or of the abdomen. The symptoms are 
the same as in reducible hernia. The tumor cannot he made to 
go back into the cavity. This form of hernia gives rise to colicky 
pains, intestinal derangement, and is liable to strangulation. As 
to treatment, the patient should be carefully watched. Let him 
wear a concave pad truss. The bowels should be moved daily. 



266 A COMPENDIUM OF PRACTICAL MEDICINE. 

Give calomel, or iodide of potassium, to reduce the fat of the 
patient, and if then the hernia can be reduced, use a truss. 

An Incarcerated Hernia is an obstruction in the protrusive 
parts by fluid, solid or gaseous contents. The causes are diar- 
rhoea, and faulty digestion with flatulence. This form is usually 
found in elderly people. The signs are pain with an increase in 
the size of the tumor; a certain degree of fullness; no heat, ten- 
derness, or tension. The symptoms are eructation of gas, but 
seldom vomiting; no circumscribed peritonitis; little or no 
pyrexia. As to treatment, employ gentle taxis, and as this is 
being done, pull the tumor gently from the ring. Apply hot 
and cold applications alternately. Give an enema high up in 
the bowels of warm water, castile soap and glycerine. 

An inflamed hernia is an inflammatory condition of the gut 
or the sac. The causes are external violence, pressure of a 
badly fitting truss, local inflammation of the intestine, or of the 
omentum. The signs are pain with no enlargement of the 
tumor, a certain degree of hardness, heat, tenderness and 
tension. The symptoms are, slight but not continuous vomit- 
ing, simply the contents of the stomach; circumscribed peritoni- 
tis radiating from the body and neck of the sac; considerable 
pyrexia. As to treatment, suspend the tumor and apply local 
applications to produce warmth and heat to the sac. Apply 
opium and lead wash to the parts. Perfect rest to the bowel 
should be insured. Internally, give opium to relieve peristalsis 
and pain. 

A strangulated hernia is where the sac or contents are so 
tightly constricted that they cannot be returned to the cavity, 
and where circulation is arrested. There are two varieties, 
active and passive. The active is where the sac is suddenly en- 
larged, or the contents become strangulated with their first 
descent. The passive becomes suddenly enlarged by the descent 
of more intestine or omentum, gas, fluid or solid into the sac. 
Strangulated hernia occurs most frequently in damp weather. 
The depression or shock is due to the sympathetic nervous 
system and not to the cerebro- spinal. It simulates cholera. In 
all cases of severe, sudden illness, look for a strangulated hernia. 



HERXIA. 267 

The Local Signs are a tumor which has either never aj3peared 
before, or if it has, is now increased in size; a tumor which is 
very painful, especially to touch, and is irreducible; a tumor 
which has lost its impulse on coughing. 

The Constitutional Symptoms are obstruction in the intes- 
tine with beginning symptoms of circumscribed peritonitis; un- 
controllable vomiting stercoraceous in character, with colicky 
pains radiating toward the umbilicus; small, quick, pulse associ- 
ated with great nervous prostration. A movement from the 
bowels may take place in strangulated hernia. 

The Sructural Changes are as follows: The intestine be- 
comes first congested, then bright red, then mahogany brown, 
then ashen gray, then purulent, and then fibro-purulent. The 
sac becomes inflamed and has a crackling sound and feel which 
denotes gangrene. 

The Treatment of strangulated hernia admits of no delay. 
Relieve the stricture and return the gut to the cavity if it is 
healthy. Before you employ taxis, give a hypodermic injection 
of sulphate of morphine (in and around the ring) to produce 
quiet and relaxation of the parts. Use a warm bath to relax the 
abdominal muscles, and the hernia may be reduced while in the 
bath. This bath is indicated in the active variety only. Vene- 
section may be used to produce fainting, to relax the abdominal 
muscles, but this is not advisable because danger may result. 
Elevate the feet so as to employ gravitation toward the abdomen. 
Use aspiration in a tympanitic gut to allow the gas to escape. It 
should never be employed where the hernia is of more than one 
or two hours standing. 

In taxis the surgeon must overcome all resistance — Hex the 
legs and relax all the muscles. Invert the patient if the hernia 
has just happened. 

Operation. — Operate at once if taxis has been employed by 
other surgeons; the sooner the better. Employ taxis just before 
the patient goes under the anaesthetic. There are four stages in 
the operation: 1. Exposure of the sac; 2. Opening the sac: 3. 
Division of the stricture; 4. Management of the hernia after ex- 
posure. 



268 A COMPENDIUM OF PRACTICAL MEDICINE. 

The incision should begin above the external abdominal 
ring one inch, and go to the bottom of the scrotum. Make the 
line of incision over the mesial line of the tumor. Cut through 
the skin first then the fascia. Look out next for three vessels, 
viz : circumflex iliac, external pudic and epigastric. Next cut 
through the external oblique, the internal oblique, cremaster and 
dart os. 

The peritoneum is recognized by its rough cellular appear- 
ance, by its adhesions to surrounding parts, by having no blood 
vessels upon it, and by its bluish color and transparency. The 
intestine can be seen under it. Open the sac at its lower end by 
taking it up between forceps. A fluid will first appear which is 
normal. Pass a director into the opening and it will move about 
freely in the cavity. Next introduce the finger into the sac, the 
finger having been immersed in a bichloride of mercury solution. 
Cut on the finger to open the sac. Then divide the stricture at 
once, and examine the gut afterward. There are three points 
where strictures may be situated, at the first ring, neck of the 
sac, or within the sac. But generally it is at the ring. 

Protect the gut. Introduce a grooved director into the ring 
and divide the stricture on the director. If the hernia is at the 
abdominal rings, cut upward and inward toward the umbilicus. 
If at the umbilicus cut toward the spleen. If at the femoral ring 
cut inward. 

Do not put back gut that is gangrenous, and do not leave 
out healthy gut. Examine it carefully, pull it down to see how 
much of a stricture there has been, and how much damage is 
done by the stricture. Note the color of the gut. If it is bright 
red and elastic, it is healthy and can go back. If reddish brown 
or black, take the thumb and index finger and pinch the gut a 
little, hold for a few seconds and let go to see if the blood comes 
back again to the part. If so it is healthy. If the gut is ashen- 
gray, collapsed, and has a cadaverous odor, it is not in a condi- 
tion to go back. If the gut is right to return, take the thumb 
and index finger and push it back little by little beginning at the 
ring. In gangrenous gut, let it slough in the wound; because the 
patient is in collapse, and the gut is inflamed, engorged and not 
in a proper condition to go back, and the sac is septic, and the 



HERNIA. 269 

gut may retract and then nature has to restore the gut. If this 
method fails then later on do resection open the wound and 
bring together the healthy ends of the gut. Keep the parts warm. 
Give the patient morphine to keep the intestine quiet. Do not 
give, however, more than two or three doses. Give no food for 
several clays, and then begin nourishment with peptonized milk. 
Give small pieces of ice to quench thirst. Move the bowels with 
enema of olive oil, warm water and soap. Do not use purgatives 
or cathartics. The abdomen may be opened and the gut relieved 
when obstructed with anything in the way of faeces. When the 
gut cannot be put back with safety, use the following treatment: 
Opium, cracked ice, and milk diet. Aj3ply warmth to the sac. 
Let the gut slough and be drawn back into the cavity as nature 
may direct. If the peritoneum has adhered to the stricture treat 
it as best you can. 

Different Kinds of Hernia. 

I. Diaphragmatic. — Is a congenital hernia in which there 
is a fissure in the diaphragm. When the opening or rent in the 
diaphragm is caused by malformation, or the arrest of develop- 
ment, it is a fatal condition. It may be caused by traumatism, 
as the fracture of a rib, or other injuries, or by the intestine go- 
ing through a natural opening in the diaphragm, on the left side 
because the liver is on the right. 

Treatment — The first kind is fatal. The second may be op- 
erated and sewed up. The third demands no treatment. 

II. Ventral. — Is a hernia anywhere in the abdominal wall, 
except at a hernial opening, as between the recti muscles, between 
the ossa innominata, between the linea alba and the linea semi 
lunaris, and as the result of traumatism. Strangulation never 
takes place in hernia due to traumatism. It usually follows lap- 
arotomy. 

Treatment. — If the hernia is great cut in and stitch the per- 
itoneum first and then the soft parts over it. 

Ill Umbilical. — Is a hernia where the cord is tied. Tt is 
caused by a malformation and comes in early life. It is also 
caused by the exertion of the infant. One kind may be situated 
above the umbilicus in the adult and not in it. 



270 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment — In children treat the hernia with a truss and one 
suitable for the purpose. In adults, a hernia above the umbili- 
cus is dangerous and is liable to strangulation. If this occurs 
the patient is most certain to die. If the patient does not die, 
he will have indigestion, which must be distinguished from acute 
indigestion and can be by persistent vomiting in hernia. It oc- 
curs four times in the female to once in the male. 

1 V. Inguinal. Varieties. — 1. Indirect inguinal hernia, or 
external, is one that goes through the inguinal canal. 2. Direct 
inguinal hernia, or internal, is one that makes its way directly 
through the external ring without having passed down the in- 
guinal canal. When the protrusion takes place above Poupart's 
ligament, through the intestinal ring r but does not traverse the 
canal sufficiently far to appear through the external ring, the 
hernia is called a bubonocele. Indirect inguinal is also called 
oblique inguinal hernia. 

Occurrence. — Three -fourths of all cases of inguinal hernia 
are on the right side of the body, because the liver is pressing 
above, and the root of the mesentary is lower down on that side, 
and most persons are right handed. It is more common in males 
than in females, because the rings are larger. Out of every 100 
cases of hernia, 84 are inguinal, 10 femoral, and 5 umbilical. 
When an inguinal hernia protrudes through the external ring 
into the scrotum, it is called a scrotal hernia. The tissues that 
cover in a hernial sac will necessarily depend upon the seat of 
the hernia. 

The treatment is the same as in other hernia. 

V. Femoral. — Is a hernia below Poupart's ligament, the pro- 
trusion having come down through the crural ring on the inner 
side of the sheath of the femoral vessels. It does not appear at 
birth, nor in early life — about twenty years of age. It is more 
frequent in women than in men, because Poupart's ligament is 
longer and weaker, and the pelvis is wider in women. The neck 
of the sac appears beneath Poupart's ligament and the fundus 
rolls up over it. 

Treatment. — Femoral hernia requires an immediate opera- 
tion. The neck of the sac is surrounded by ligamentous tissue 
which is unyielding and the danger is great. 



HERXIA. 271 

VI. Obturator. — Is a hernia which coraes out through the 
obturator foramen. It is most frequent in females on account of 
the greater inclination of the pelvis. 

Signs and Symptoms. — There is a tumor at the inner side of 
the thigh and femoral vessels. There is pain in the knee joint 
owing to pressure of the tumor on the obturator nerve, and the 
jDain is increased by extending the leg, and by rotating the thigh 
outwards. Other signs are the same as in any other hernia. 

Treatment. — Gentle taxis is generally sufficient. It often 
becomes strangulated. 

VII Ischiatic. — Is a hernia which comes out through the 
ischiatic notch, above or below the pyriform muscle, and under 
cover of the gluteus maximus. 

Symptoms. — Same as in any other hernia with one extra — a 
tumor found on a line drawn from the trochanter major to the 
sacro-iliac synchondrosis. 

Treatment. — Careful taxis. If strangulated operate. 

VIII. Vaginal. — Is a protrusion at the upper and posterior 
part of the vagina. It comes usually after parturition. 

Symptoms. — Has all the signs of inguinal hernia and an 
impulse on coughing. It is a smooth, soft tumor increasing in 
the upright and decreasing in the recumbent position. It causes 
tenesmus and cystitis. It is reduced by taxis. 

Diagnosis. — It may be mistaken for cystocele. The diag- 
nosis is made by introducing a male sound. It does not become 
strangulated. 

Treatment. — It is easily reduced and kept back by a ring 
pessary. It should be reduced before labor. 

IX. Pudendal. — Begins like vaginal. Comes out between 
the vagina and the levator ani muscle, lies in the long axis of 
the vagina, presents at the side of the ascending ramus of the 
ischium. 

Treatment. — It is easily reduced and kept back by a truss. 

X. Perineal. — Is a hernia between the rectum and bladder 
in the male, or between the rectum and vagina in the female. It 
is more frequent in the female on account of a greater pelvis. 

Signs. — Are the ordinary ones. It forms a tumor between 
the tuber-ischii, which increases in size when standing. 



272 A COMPENDIUM OF PKACTICAL MEDICINE. 

Treatment. — Use a special perineal truss after reducing it. 
Tumors Which Are Confounded with Hernia. — 1. Hydrocele. 

2. Spermatocele. 3. Hematocele. 4. Varicocele. 5. Undes- 
cended Testicle. 6. Solid Tumor of Testicle. 7. Abscess. 

I. Hydrocele. — 

Signs. — 1. Slow growth from below upwards. 2. It has a 
tense elastic feel. 3. Transparency. 4. Absence of impulse on 
coughing. 

II. Spermatocele. — 

Signs. — 1. Situated above the testicle. 2. Notched appear- 
ance from pressure on the cord. 3. Marked mental effect. 4. 
Spermatozoa seen under the microscope. 

Ill Hematocele. — 

Signs. — Sudden growth following traumatism. 2. Soft fluc- 
tuating feel. 3. Ecehymosis of scrotum, pain and tenderness. 
4. Irreducibility. 

IV. Varicocele. — 

Signs.— 1. Slow growth from below upwards. 2. Feels 
similar to a bag of worms. 3. Reducible, but will return with 
pressure over ring. 4. It does not involve the spermatic cord. 

V. Undescended Testicle. — 

Signs. — 1. Testicular sensation. 2. Pain upon pressure. 

3. Absence of a testicle in the scrotum. 4. Absence of an im- 
pulse on coughing. 

VI. Tumor of Testicle. — 

Signs. — 1. Circumscribed size. 2. Doughy, lobulated feel. 
3. Constant situation below inguinal canal. 4. Absence of an 
impulse on coughing. 

VII. Abscess. — 

Signs. — 1. Sense of fluctuation. 2. Inflamed integument. 
3. Returns without a gurgle. 4. Peculiar impulse on coughing. 

HYDRONEPHROSIS. 

Called, also, dropsy of the kidney, consists of an accumula- 
tion of urine and dilatation of the pelvis and calices, with pro- 
gressive atrophy of the renal structure (Bartholow). 

Causes. — It is caused by some obstruction in the urinary 
passages. The obstruction may be seated in the bladder, pelvis, 



HYDRONEPHROSIS. 273 

ureter, bladder, or urethra. It is usually unilateral. It may be con- 
genital or acquired. Congenital causes are: 1. A supernumerary 
renal artery compressing the ureter. 2. Narrowing of the lumen 
of the ureter. 3. A valve -like impediment produced by an 
oblique insertion of the ureter into the pelvis of the kidney. 
4. Insertion of the ureter into the upper, instead of the lower 
part of the pelvis. The congenital is often associated with mal- 
formations of other parts, as imperforate anus, hare-lip, etc. 

The acquired causes are : 1. The ureter may be blocked by 
a calculus, by coagula of blood, or by parasites. 2. Diseases of 
the walls of the ureters. 3. Pressure upon the ureter from 
without, by a tumor, by a displaced uterus, etc. 4. Diseases of 
the bladder which involve one or both of the orifices of the 
ureters. 5. Stricture and hypertrophy of the prostate (Bartholow, 
Loomis and Flint). 

Symptoms. — An important diagnostic sign is the discovery 
of a tumor in the lumbar region. The tumor is fluctuating and 
usually lobulated. It causes no pain except by its pressure. In 
growing, adhesions form which give rise to acute stabbing pains 
at the time of their formation. If the tumor presses upon the 
colon, constipation results; if upon the diaphragm, dyspnoea will 
result; if upon the stomach, there will be nausea and vomiting; 
if the tumor rests upon the abdominal aorta, a pulsation will be 
communicated to it. A symptom of almost pathognomonic value 
is the disappearance of the tumor coincident with the discharge 
of a large quantity of pale liquid by the bladder. The course of 
the disease is chronic, and the formation of the tumor slow (Bar- 
tholow, Loomis and Flint). 

Differential Diagnosis. — Hydronephrosis may be confounded 
with ovarian cysts, ascites, hydatid cysts and pyonephrosis. In 
ovarian cysts, the tumor develops from below. Vaginal and 
rectal examinations will aid. In ascites, when the position of 
the patient is changed there is a change in the level of dullness, 
which never occurs in hydronephrosis. It cannot be distinguished 
from hydatid cysts unless hydatid vessels are found in the urine. 
It is distinguished from pyonephrosis by a non-purulent charac- 
ter of the urine, and by the absence of constitutional symptoms. 

Treatment. — Remove the cause of obstruction if possible. 



274 A COMPENDIUM OF PRACTICAL MEDICINE. 

Removal of the liquid by aspiration has proved successful. A 
small aspirating needle or trocar should be used. Free opening 
and drainage is a favorable surgical procedure. Medicine will 
accomplish nothing. 

HYDROPHOBIA. 

Called, also, rabies, is a specific disease due to the inocula- 
tion of a poison contained in the saliva of rabid animals, notably 
the dog, and characterized by pain and stiffness of the inoculated 
part; by exaltation of the reflex faculty, by spasms of the throat 
on the attempts to swallow, and subsequently at the sight of 
liquids; by delirium, exhaustion and death (Bartholow). 

Causes. — The inoculation of man with a specific virus con- 
tained in the saliva of the dog, cat, wolf, fox, and some other 
rabid animals, is the sole cause of the disease. A certain predis- 
position seems necessary, for, of all persons bitten by rabid 
;animals, only a small proportion are attacked by hydrophobia. 
The teeth, in inflicting the wound, pass through the clothing, 
which removes the saliva, and therefore the most of those bitten 
through the clothing escape infection. All ages and both sexes 
are liable. Apprehension, fear, excesses of all kinds, fatigue, 
etc., favor the occurrence of the disease (Bartholow). 

Symptoms. — The period of incubation varies from a few days 
to several months or even years. During the invasion of the 
disease if the wound has not healed, it takes on a livid appear- 
ance, and becomes painful; if it has healed, the scar becomes red, 
irritable, swollen and painful. Sometimes a sensation of cold- 
ness and of numbness is felt in the bitten member. These local 
symptoms are soon followed by systemic disturbances. The pa- 
tient is depressed, apprehensive, melancholic and peevish. The 
first is called the melancholic stage. There may be slight con- 
striction of the throat, and difficult swallowing. These symp- 
toms increase in severity for two or three days, when the patient 
passes into the convulsive stage. In this stage, there is great 
restlessness, the eyes have a wild look, are bright, staring, and 
constantly moving. The mouth and throat are dry, congested, 
and covered with thick, tenacious saliva which gathers about the 
lips in frothy masses. 



HYDROPHOBIA ICHTHYOSIS. 275 

Thirst is intense, but the patient cannot drink. The sight 
of water, or the thought of drinking brings on violent spasms of 
the muscles of deglutition and respiration. There is intense 
hyperesthesia, and convulsions follow attempts at drinking. In 
rare cases there is a paraplegic stage. The hawking and spitting 
of the patient seems like the bark of a dog. Patients often be- 
come violent. 

Duration. — Hydrophobia is a very acute disease. The whole 
duration of the disease is comprehended in three days to two 
weeks (Bartholow andLoomis). 

Prognosis. — Is most unfavorable. 

Treatment. — When the bite of a rabid animal has been re- 
ceived, the wound should be scarified, cauterized with a hot iron, 
or every part of it touched with nitrate of silver. Permanganate 
of potassium should be tried. There is no specific to prevent 
the disease, unless Pasteur's inoculations with the modified virus, 
have this power. Of all the remedies proposed, curare is the 
only one which seems to possess any power over hydrophobia. 
One-third grain should be given every fifteen minutes (Bartholow 
and Loomis). 

ICHTHYOSIS. 

Called, also, fish- skin disease, is a rare malady. It is not so 
much a disease as a deformity. 

Causes. — The cause is unknown. 

Symptoms. — There is excessive proliferation of the cells of 
the epidermis. The skin is thickened, dry, coarse, wrinkled, and 
discolored. There is defective action of the sudoriparous and 
sebaceous glands. The scales resemble those of a fish (An- 
derson). 

Treatment. — A long course of arsenic is useful. The hypo- 
dermic injection of 1 of a grain of pilocarpine may be used from 
time to time. The local treatment consists in the frequent use 
of baths. Oily substances may be applied to the skin to keep it 
soft (Anderson). 



276 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR ICHTHYOSIS. 

R Cupri sulphatis gr. x. 

Unguenti sambuci gj. — M. 

Sig. : Use locally. — Wilson. 

R Pulv. camphorse gr. x. 

Ungt. zinci oxidi gj. — M. 

Ft. Ungt. 
Sig. : Use locally. — Erasmus Wilson. 

R Ulmi corticis ^iiss. 

Aquas bullientis Oj . — M. 

Ft. haustus. 
Sig.: A wineglassful or two thrice daily. — Lettson.. 

IMPETIGO. 

Is an acute pustular, inflammatory cutaneous disease. It is 
the pustular form of eczema. (See eczema.) 

Treatment. — The glycerite of tannin is an excellent applica- 
tion for impetigo. Skin- diseases, as impetigo and ecthyma,, 
usually arising from a feeble state of the assimilative function, 
are cured by quinine. Nitric and nitro- hydrochloric acids have 
been used with advantage for the cure of impetigo, when depend- 
ent upon indigestion (Bartholow). 

PRESCRIPTIONS FOR IMPETIGO, 

R Plumbi acetatis gr. xv. 

Acidi hydrocyan dil ZHxx. 

Alcoholis gss. 

Aqua) ^vss. — M. 

Sig.: Apply locally. — Bartholow. 

R Zinci oxidi gij. 

Glycerinre ^ij. 

Liq. plumbi subacetatis ^iss. 

A quae calcis ad gvj. — M. 

Sig.: Apply locally. — Fox.. 

R Unguenti zinci oxidi §j. 

Sig.: Apply locally. — Ringer. 

R Syrupi hypophosphiti comp gvi. 

Sig.: A teaspoonful thrice daily in water. — Jamieson^ 



INDIGESTION INFLAMMATION. 277 

INDIGESTION. (See Dyspepsia). 
INFLAMMATION. 

Is that nutritive disturbance which is characterized by ac- 
tive hyperemia or congestion, and active multiplication or pro- 
liferation of the cells of a tissue or organ (Gross). 

Causes. — Are predisposing and exciting. The predisposing 
are gout, syphilis, scrofula, shock, loss of blood, impaired nerv- 
ous action, bad habits, diabetes, anaemia, etc. The exciting 
causes are cold or heat, injuries, acid or alkalies, parasites, 
and the results of the ptomaines of micro-organisms on the tis- 
sues. 

. Symptoms. — A part is acutely inflamed when it is hot, red, 
swollen and painful. The local symptoms are : 1. Redness, which 
is caused by an afflux of blood to the part. Redness is not al- 
ways a sign of inflammation, unless it be permanent. 2. Heat, 
which is always present, and is due to an increased flow of blood 
to friction against the walls of the vessels of the part and to cell 
proliferation. The inflamed part is a heat-producing area, thus 
causing fever by overheating the blood. 3. Swelling, which is 
due to capillary engorgement, and effusion of serum into the tis- 
sues. The swelling is greater where the tissues are lax. And 
4. Pain, which is usually felt at the seat of the morbid action. 
Pain sometimes suddenly leaves a part, which is a sign of com- 
mencing mortifl cation. The causes of pain, are compression, 
stretching, irritation and disorganization of nerves. Its charac- 
ter varies; it may be sharp and lancinating, as in inflammation of 
serous membranes; acute and throbbing, as in formation of pus; 
dull and heavy, as in periostitis; annoying, as in toothache; sick- 
ening, as inflammation of the testes, itching, as in affections of 
the skin; or burning and scalding, as in gonorrhoea. The pain 
in inflammation comes on gradually, is persistent, aggravated by 
pressure and muscular contraction, and is fixed; there is febrile 
disturbance, accompanied by redness, heat and swelling. The 
pain of spasm comes on suddenly, is intermittent, relieved by pres- 
sure; is not fixed, there is no fever, and is not accompanied by 
redness, heat or swelling. The of pain neuralgia is paroxysmal, is 



278 A COMPENDIUM OF PRACTICAL MEDICINE. 

aggravated by pressure, is not fixed, and is unaccompanied by 
fever, redness, heat or swelling. 

Constitutional Symptoms. — In mild cases there is no consti 
tutional disturbance, but if the inflammation be at all severe 
fever will follow. The fever is usually ushered in with a chill 
The tongue becomes furred and unclean, there is great thirst 
want of appetite, the bowels are constipated, the urine is scanty 
the skin hot and dry, and the heart's action increased (Com 
pend). 

Products of Inflammation. — Are fibrin, serum, pus cells and 
red blood- corpuscles. The first effect of the application of an 
infiammatory irritant is a dilatation of the arteries, then of the 
veins, and last of all, of the capillaries. At the same time the 
velocity of the blood- current is increased. After a time the blood 
flows less rapidly, and in the capillaries it may come to a com- 
plete stagnation or stasis. At this time the white corpuscles 
migrate from the veins and capillaries, but not from the arteries. 
The red corpuscles pass through the capillary walls by a process 
known as diapedesis (Flint). 

Treatment. — Remove the exciting cause if possible. The 
general treatment is rest and elevation and relaxation of the 
affected part. The local treatment in the stage of congestion is 
bleeding. This may be affected by punctures, scarifications, 
leeching, or cupping. Leeches should not be put on the inflamed 
surface, but between the inflamed part and the heart. If it is 
desired to remove a leech after a certain time, this may be ac- 
complished by sprinkling salt upon it. The bleeding may be 
stopped by applying to the part nitrate of silver, muriated tinc- 
ture of iron, or styptic cotton. The now of blood from a leech- 
bite may be continued by the application of warm water. The 
application of cold is frequently of service. It contracts the 
calibre of the capillaries. When the second stage, or that of effu- 
sion, is established, compression by bandages is useful. Acetate 
of lead is applicable to all cases of external inflammation (eight 
grains to an ounce of water). When the third stage, or that of 
suppuration, is reached, the application of heat and moisture by 
means of warm baths and poultices is the best. 

Constitutional Treatment. — In strong, robust individuals, 



INFLAMMATION IMPOTENCE. 279 

blood-letting may be resorted to in the first stage of inflamma- 
tion. Arterial sedatives such as tincture of veratrum viride, 
aconite root, gelsemium and tartar emetic are indicated in the 
first stage of inflammation. The diaphoretics in general use are 
acetate of ammonium, citrate of potassium, Dover's powders, 
fluid extract of jaborandi, muriate of pilocarpine and lemon 
juice with bicarbonate of potassium. The diuretics in use are 
infusion of digitalis, salts of potassium, citrate of caffein, coffee, 
etc. Cathartics are used to evacuate the bowels, deplete the 
mucous membrane, and to stimulate the absorbents, and thereby 
remove the inflammatory deposit. Enemata of warm water, or 
soap and water may be used to unload the bowels. Emetics are 
indicated when the skin is hot and dry, the tongue heavily coated, 
and great weight in the epigastrium. Anodynes. — Opium is 
applicable to the treatment of inflammation in all stages of the 
disease. It should be preceded by a cathartic. It must be given 
in full doses, as small doses act as stimulants, while larger doses 
act as sedatives. Hypnotics. — When the patient is restless, but 
not suffering acute pain, hypnotics are indicated, such as bromide 
of potassium gr. xxx., chloral gr. xx., taken at bedtime 
(Compend). 

IMPOTENCE, 

Is a symptom, and means inability to perform the act of 
coition. Impotence must be carefully distinguished from steril- 
ity, which signifies inability to beget offspring on account of 
defect in the semen, whether the individual can have sexual in- 
tercourse properly or not. A man may be impotent and virile, 
or impotent and sterile, or potent and sterile. 

The sexual act is a compound one, physical and mental. 
The physical organs may be perfect and capable in their way; 
but if the mental are deficient in energy, or weakened by doubt 
of competency, or under the influence of some emotion such as 
shame or fear, the sexual act will be spoilt, and failure to com- 
plete it must ensue. 

Impotence may involve absence of sexual desire, or it may 
exist without loss of sexual desire. Different person- in health 
differ widely as regards the venereal propensity; in some persons 



280 A COMPENDIUM OF PRACTICAL MEDICINE. 

the sexual desire is intense, in others it is feeble and sometimes 
wanting. The propensity may be increased by indulgence and 
diminished by an opposite course. In the marital relation cold- 
ness may depend on personal antipathy and is a frequent source 
of domestic unhappiness (Bryant and Flint). 

Impotence may be considered as true and false. True im- 
potence is exceedingly rare in the male. 

Causes. — 1. Absence of penis. 2. Minute size of penis is 
only a relative cause. 3. Extreme size of the penis is a relative 
cause. 4. Extreme epispadias and hypospadias. 5. Large size 
of the prepuce, tight and narrow orifice, tumors or growths upon 
or about the penis, and excess of abdominal fat. 6. Very tight 
stricture of the urethra. 7. Aspermatism. 8. Imperfect, irreg- 
ular and bent erections. 9. Eunuchs. 10. Prolonged sperma- 
torrhoea. 11. Partial erection, attended by rapid ejaculation, is 
a common variety of impotence, due usually to continence, 
over- excitement, etc. In this case, the patient should practice 
the sexual act in the early morning rather than the evening. 
Circumcision may sometimes be necessary to diminish the sensi- 
tiveness of the glans penis, which is often over -acute. 

Treatment. — Remove the cause if possible. 

FALSE IMPOTENCE. 

Causes. — In false impotence, the cause is always nervous, or 
it may be a moral one; and there is often no impotence at all, 
except in the mind of the individual. Sexual indifference, as a 
result of sudden shock, grief, excessive joy, fright, repugnance 
and lack of affection for the individual, is a cause. Under the 
two latter circumstances the patient will sometimes think of an- 
other person than the one with whom he is lying, and thus main- 
tain erection and effect ejaculation. The sudden flooding of the 
vagina with warm mucus will sometimes cause erection to cease 
at once. Rouband speaks of a man who became impotent on 
diawing a prize of thirty thousand francs in a lottery. The 
same author mentions another curious cause of false impotence : 
A young man brought up in the country was, at the age of four- 
teen, initiated into the mysteries of Venus, by a young friend of 



IMPOTENCE, 281 

the family, twenty -one years old. Her hair was light, and worn 
in curls, and for precaution's sake, she never had intercourse 
with the boy except when dressed — that is, wearing a corset, 
high boots and a silk dress. A dark beauty had no power over 
him, and a night-dress extinguished all his fire. In after life, he 
found himself utterly impotent except in the company of a light 
haired woman, wearing curls, with high boots, a corset arid a silk 
dress (Keyes). 

Treatment. — It is necessary to arouse the moral sentiment of 
carnal desire by favorable relations to the sex — opera, theatre, etc. 
The power of the organs is increased by general dry friction of 
the whole body, by massage and flesh-brush, cold-bath, sea- 
bathing, generous diet, tonics, the mineral acids, strychnine, er- 
got, and especially phosjjhorus and cantharides, or the two com- 
bined, commencing at a fair dose, one -fortieth of a grain of the 
former to ten drops of the tincture of the latter, three or four 
hours before the desired erection, and increasing the dose care- 
fully. Cantharides produces erection without desire, and phos- 
phorus with desire. Electricity, and local applications of mus- 
tard are sometimes serviceable in recalling erection. 

Nervous Impotence. — Is the most common form of false im- 
potence. It occurs in young men. The patient can provoke 
erection at will and awakes with erection, but when in the pres- 
ence of a woman, and when he desires to have sexual intercourse, 
his organs will not respond, or if erection comes on, it lacks full 
energy. 

Causes. — This form of impotence is the result of unnatural 
excitement of the sexual functions. It may come from protracted 
chastity, ungratified desire, or excessive erotic excitement at the 
time. After prolonged chastity and great desire, the sufferer has 
probably approached a female, and at the portals of success his 
erection has failed him. The mental depression following an 
experience of this sort is of the most exaggerated nature. He 
thinks he is impotent beyond all doubt. The cunningly con- 
ceived advertisements of charlatans in newspapers envelop him 
further in deep despair. He is now without a ray of hope 
(Keyes). 

Treatment. — The best treatment for a man witli nervous im- 



282 A COMPENDIUM OF PRACTICAL MEDICINE. 

potence is to instruct him in sexual physiology and hygiene, and 
get him married, with the advice to attempt no intercourse, and 
awaiting some morning when awakening with a vigorous erec- 
tion, to accomplish coitus promptly, without delay or dalliance. 
The act once accomplished the charm is broken. The use of the 
steel sound and of local applications of tannin, often of decided 
service where ejaculation is too rapid, are also sometimes useful 
here (Keyes). 

PRESCRIPTIONS FOR IMPOTENCE. 

R Tinct sanguinarise giij . 

Ext. stillingise fid 3v.— M. 

Sig. : Fifteen or twenty drops in water thrice daily. 

— Bartholow. 

R Zinci phosphidi gr. ij. 

Confect rosse gr. xx. 

Sig. : One to three pills three times daily. — Bartholow. 

R Ext. cannabis indicse 

Ext. nucis vomicae aa gr. xv. 

Ext. ergotse aquosi ■•••3J- — M. 

Ft. massa et. in pil. no. xxx. div. 
Sig. : A pill morning and evening; — DaCosta. 

R Tinct. phosphori giss. 

Tinct. cantharides siijss. 

Elixir simplicis ad %v. — M. 

Sig. : One teaspoonful three or four hours before retiring. In- 
crease dose carefully. — Van Buren and Keyes. 

INCONTINENCE OF URINE. (See Enuresis). 

INFLUENZA. 

Called also epidemic catarrh, la grippe and catarrhal fever, 
is a specific epidemic disease, self -limited, characterized by ca- 
tarrh of the respiratory organs, and sometimes of the digestive, 
and by nervous symptoms and debility (Bartholow). In 1830 
and 1831 a severe influenza epidemic swept over the whole civ- 
ilized world (Loomis). 

Causes. — All conditions and all ages suffer alike. The dis- 
ease has passed over the whole of Europe in six weeks. It rarely 
continues in one locality more than two months. The usual dur- 



INFLUENZA. 283 

ation of an epidemic is two to four years. It seems to be clue to 
some special morbific principle in the atmosphere (Loomis). 

Symptoms. — Influenza comes on suddenly. A feeling of 
chilliness, flashes of heat, and a feeling of lassitude are followed 
by symptoms of a severe naso- pharyngeal catarrh, with frontal 
headache, pains in the limbs and back, soreness of the throat, 
hoarseness and a frequent racking cough, difficult breathing and 
constriction across the chest. The sputa are at first mucous 
and then scanty, later copious and muco-purulent. There is great 
prostration. Sudamina appear on the surface and herpes on the 
lips. There is anorexia. There may be nausea and vomiting. 
The face becomes congested and livid, the pulse increases, the 
tongue becomes dry and brown, and the temperature rises. In 
mild cases the disease is at its height on the third day. In severe 
cases, convalescence does not commence until the tenth or twelfth 
day (Loomis). 

Prognosis. — Is good except in the very old, very young, and 
the debilitated. Complications make the prognosis graver. The 
most frequent complications are laryngitis, bronchitis, pulmo- 
nary congestion, pneumonia and pleurisy. Herpes labialis 
occurs often (Loomis). 

Treatment. — Repose in- doors, and at the outset a full dose of 
quinine and morphia (gr. xv. — gr. ss.) exercises a favorable influ- 
ence. Also in the early stages, a half ounce of liquor ammonii 
acetatis, and one grain of pulvis ipecac, every two or three hours 
is all that is required. The bowels should be kept freely open 
with salines. If patients are restless, Dover's powders may be 
given in small doses. For the prostration give stimulants. For 
the local distress in nose and throat, inhale the vapor of hot 
water. 

Bartholow gives the following: 

R Extracti ipecacuanha fld 3ij. 

Tinct. opii deodoratse 5iv. 

Tinct. aconiti radicis gj". — M. 

Sig. : Six to ten drops every two hours. For the violent head 
symptoms bromide of potassium may be given. 

(Loomis and Bartholow). 



284 A COMPENDIUM OF PRACTICAL MEDICINE. 

INGROWING TOE=NAIL. 

This is a troublesome and painful affection. It occurs most 
frequently on the great toe. 

Causes. — Tight narrow- soled shoes and boots. The pressure 
causes the nail to cut its way into the tissues, the tissues become 
hypertrophied and ulcerate, and granulations spring up from the 
side of the nail (Sayre). 

Treatment.— Remove the exciting cause. In mild cases, 
insert a small piece of cotton or lint under the nail. After the 
application of the cotton, the granulations should be brushed 
over with nitric acid or nitrate of silver. Another plan of treat- 
ment is to cut a gutter in the center of the nail, which has a 
tendency, it is said, to elevate the corners. Still another plan is 
to divide the nail on a line with the incurved edge, and strip it 
off, together with the matrix (Sayre). 

PRESCRIPTIONS FOR INGROWING TOE=NAIL. 

{£ Liquor potassse gij. 

Aquse 3j . — M. 

Sig. : Apply on cotton to the margin of the nail at the ulcerated 
surface to soften the nail. — Bartholow. 

jfc Acidi tannici Jj. 

Aquas destillatse 3vj . — M. 

Sig.: Paint over parts daily. — Biall. 

Jfc Plumbi (pulv.) acetatis £j. 

Tinct. opii Sj- 

Aquse ad ^ viij . — M. 

Sig.: Shake well and apply constantly until the inflammation is 
reduced and pain alleviated. Then insert a pledget of cotton under 
nail, and apply following : 

|fc Argenti nitratis gr. xxx. 

Aquse destillatse §j. — M. 

Sig.: Apply two or three times daily with a brush. — Davidson. 

INSOMNIA. 

Is sleeplessness. It occurs in cerebral congestion and in- 
ilammation. But a person maybe sleepless from excessive pain, 
from exhaustion, from grief, from mental excitement or fatigue, 



INSOMNIA. 285 

or from the free use of coffee or tea. In several of these states, 
congestion is the immediate cause of the wakefulness. Insomnia 
attends the delirium of typhoid fever, but is most marked in 
delirium tremens. 

Treatment. — When wakefulness is due to a condition of cere- 
bral anaemia, a full dose of some alcoholic fluid, whiskey or 
brandy, will produce sound and refreshing sleep. In some 
persons a glass of ale or beer answers better. Sulfonal in doses 
of 30 to 60 grains, causes sleep that is physiological in character, 
but pain hinders its action. Cases of sleeplessness, due to 
mental over-work, anxiety or physical fatigue are entirely re- 
lieved by fifteen to twenty grains of chloral. The bromide of 
potassium is effective in the same cases. Morphine and atropine 
is the best sleep-producer in cases of pain, in some kinds of 
mania, and in melancholia. A hop-pillow has induced sleep. 
Galvanization will sometimes cause sleep. A tepid or warm bath 
at bedtime will often produce sleep (Bartholow). 

PRESCRIPTIONS FOR INSOMNIA. 

B Paraldehyde oiiss. 

Alcoholis (90 per cent.) Siss. 

Tinct. vanillse 3ss. 

Aquas §ij. 

Syr. simplicis....ad giv. — M. 

Sig. : One or two teaspoon fuls every hour. — Yvon. 

& Ext. piscidiaa erythrin fid.... 3j. 

Syr. simplicis Sj. 

Aquas auranti nor 5 i v. — M. 

Sis:.: A teaspoonful to a tablespoonful at bedtime. — Payne. 

R= A ntipyrin 5 j . -ij • 

Syr. auranti cort oj. 

Aquse cinnamomi ad Siij. — M. 

Sig. : One tablespoonful every hour or two till effective. 

— Williams. 

R Amyl hydratis gr. xiv. 

Syr. auranti cort 5ss. 

Aquse 5j . — M. 

Sig.: Take at bedtime. — Von Mering. 



286 A COMPENDIUM OF PRACTICAL MEDICINE. 

R Methylol gj. 

Syr. auranti fior Siv. — M. 

Sig. : One teaspoonful at bedtime. — Richardson. 

R Potassii bromidi 3iv. 

Chloral hydratis 5ij. 

Syr. pruni virgin Sj. 

Aquas ad Siij. — M. 

Sig.: A dessertspoonful in a glass of water at bedtime. 

INTERMITTENT FEVER. (See Malarial Fever). 

INTERTRIGO. 

Is chafing of adjacent parts. It is a form of erythema. It 
occurs at parts where opposed surfaces of skin are in contact 
with one another, as between the hips, at the flexures of the 
thighs, in the arm -pits, and under pendulous mammae, the inflam- 
mation being favored by the heat, moisture, and friction of the 
parts. It is especially apt to occur in hot weather, in the case of 
corpulent persons, and in infants. The affected surface has 
a reddened glazed appearance and the itching is often intoler- 
able (Anderson). 

Treatment. — Violet powder is used to prevent intertrigo in 
infants. In intertrigo and in the erythema which occurs about 
the genitals of infants, dusting the affected surface with bismuth 
soothes the pain and promotes healing. Tannin in powder, or 
the glycerites of tannin, applied to the affected surface is very 
effective. The following lotion is useful: 

R Aluminus gr. xx. 

Zinci sulph gr. x. 

Glycerinse 3j . 

Aquae rosse Siv. — M. 

Sig. : Apply to affected surface. — Bartholow. 

Camphor is a useful addition to dusting powder to allay the 
heat, tingling and itching of eczema and intertrigo (Ringer). 



i^testi]S"al obstruction. 287 

PRESCRIPTIONS FOR INTERTRIGO. 

R Pulveris amyli ,^iv. 

Zinci oxidi §j • 

Zinci carbonatis Iss.— M. 

Sig.: Use as a dusting powder. — Tilbury Fox. 

R Acidi boracici giss. 

Vaselini 3J . — M. 

Sig. : Apply locally after washing and drying the parts. — Waring. 

R Bismuthi subcarbonatis ^ij. 

Sig. : Use as a dusting powder. — Bartholow. 

R Ammonii sulphoichthyolati gr. iij. 

Cumarini gr. xij. 

Unguenti petrolei 3v. — M. 

Sig.: Apply with the finger after bathing and drying the child. 

— Lorens. 

R Linimenti aquse calcis gvi. 

Sig.: Use locally. —Tilbury Fox. 

INTESTINAL CATARRH. (See Enteritis.) 

ITCH. (See Scabies.) 

INTUSSUSCEPTION. (See Intestinal Obstruction.) 

INTESTINAL OBSTRUCTION. 

Is a mechanical impediment to the movement of the bowels. 
It may be complete or incomplete. 

Inquire of the patient: 1. If he has ever had a previous 
peritonitis, or intestinal troubles, as colic, pains, etc. 2. The 
manner in which the attack appeared, whether suddenly or grad- 
ually. 3. If there is any exciting cause present, as a hernia, 
swallowing a foreign body, etc. The obstruction may come on 
while the patient is asleep or in perfect health, or after an indi- 
gestible meal, or while straining at stool with a distended blad- 
der. As certain as obstruction occurs in the small intestine, 
acute symptoms are developed, vomiting of bile comes on sud- 
denly, and tympanites is absent generally. Collapse is profound. 
The shape of the abdomen is similar to the pregnant. If the 
obstruction occurs in the large intestine, chronic symptoms are 



288 A COMPENDIUM OF PRACTICAL MEDICINE. 

developed, and there is fixed pain, and tympanites with disten- 
sion of the colon. Collapse is less profound. Great distension 
of the abdomen develops rapidly. It occurs late in life. 

Causes. — /. Strangulation inside of the cavity. 

II — Changes within the lumen of the gut. 

Ill — Changes without the lumen of the gut. 

The causes of strangulation of the bowels are: 1. Peri- 
toneal adhesions by bands, over loops, through apertures, or at- 
tachment to the viscera, (the result of acute peritonitis). 2. 
False diverticulum. 3. Hernia. 4. Volvulus. 5. Intussuscep- 
tion. 6. Kinking of the gut. 

The causes of changes without the lumen of the gut are: 1. 
Compression from anything outside of the gut. 2. Contraction 
of the mesentery following inflammation of the same. 3. Chronic 
peritonitis. 4. Retroflexed uterus especially during pregnancy. 

The causes of changes within the lumen of the gut are: 1 
Stenosis or stricture from malignant growths or ulcerations. 2. 
Gall-stones. 3. Foreign bodies. 4. Enteroliths. 5. Fsecal im- 
paction. 

False Diverticulum. — May be the result of the viteline duct 
remaining pervious in the fetus, or of a small piece projecting 
from the ileum like the finger of a glove, from one to three feet 
above the ileo-cgecal valve, or it may be formed from the mucous 
coat, by a rupture of the muscular coat, making a hernia of the 
mucous coat. 

Hernia. — As a cause of intestinal obstruction, is formed by 
weakening of the walls of the intestine, and is found on the 
mesentric borders of the gut. The cause may also be faecal 
matter. The pouch comes from the ileum three to four feet 
above the ileo-csecal valve. 

Volvulus. — Is the twisting of the gut upon its own axis, or 
upon the mesenteric axis. It occurs most frequently in the ileum 
colon, caecum and sigmoid flexure. Thirty-three of 1000 cases 
are due to volvulus. Russians suffer more than other nationali- 
ties, because they have eight feet more of ileum, and eat a more 
vegetable diet. In the ileum it goes from left to right and once 
upon the mesenteric axis. It occurs at about twenty years of age. 
This variety comes on very suddenly, and with no assignable 



INTESTINAL OBSTRUCTION. 289 

cause. Give an enema early, and reach and distend the colon 
and percuss it, then you will know whether the obstruction is 
above the ileo-csecal valve or below it. In the sigmoid flexure, 
it is very common in chronic constipation as the bowels become 
filled by faecal matter and gas, and fall over each other. Gener- 
ally occurs after middle life, after 40 years of age. Tenesmus is 
very distressing in the bowels. Volvulus may come from trau- 
matism, as a stabbing into the abdomen; also, from active peris- 
talsis when the gut twists upon itself. 

Intassiiscejition. — Is where one part of the bowel is thrust 
into another part. It is, also, called invagination. One-third of 
all cases of intestinal obstruction is of this kind. Twenty- five 
per cent, occur before the first year, and fifty per cent, before the 
tenth year. It most frequently occurs in the ileum, colon, ileo- 
cecal valve, and rectum. It is caused by irregular contraction 
of the bowels, and has been produced on animals by electricity. 

If there be an intermittent pain, it denotes that the obstruc- 
tion is incomplete. If there be a continued pain it shows that 
the obstruction is complete. Bloody stools are seen in eighty 
per cent, of the cases. 

Stenosis or Stricture from Malignant Growths or Ulcera- 
tions — is due to peptic, typhoid, tubercular, catarrhal, syphilitic 
and dysenteric ulcers. Peptic ulcer is found in the duodenum 
and is said to be due to the action of the gastric juice. It occurs 
in middle life. Typhoid ulcers are found in the long axis of the 
gut of the ileum. The tubercular ulcers are found in the lower 
ileum, and originate in the lymphatic glands, and lie in the 
transverse direction of the gut. Catarrhal ulcers are found in 
the colon, and are produced by chronic constipation. They are 
in large numbers and produce gangrene of the mucous membrane. 
Syphilitic ulcers are usually found in the rectum, in the submu- 
cous tissue, and are broken down gummata. Dysenteric ulcers 
are found in the rectum and sigmoid flexures. Stenosis from ma- 
lignant growths are usually from carcinoma (epithelioma) and 
may be primary or secondary. It usually forms an annular 
stricture and there comes just above the stricture dilatation and 
hypertrophy of the bowel. 



290 A COMPENDIUM OF PRACTICAL MEDICINE. 

Gall 8 tones — Which produce obstruction are usually small 
but become enlarged when passing through the intestine by co- 
hering together. The symptoms are not so sudden or great, as 
by bands or loops. There are previous hepatic colic, and the 
presence of jaundice usually. It is more frequent in women then 
in men. 

Foreign Bodies — Are any bodies not acted upon by the gas- 
tric juice. These may be swallowed for suicide or by the insane 
or accidentally. 

Enteroliths — Are intestinal calculi. They are composed of 
pnosphorus, calcium, magnesium carbonate, with cholesterine, 
and are formed about a necleus. This form of trouble is fre- 
quent in Scotland where the peasants live on coarse oatmeal. 

Fwoal Impaction — Is due to the faeces which become hard 
and tend to remain in the bowel. The bowels move very seldom 
once in three or four weeks, and thus it is a cause of local ob- 
struction. In all cases a tumor can be felt under the integument 
and the feeling is like that of putty. A bucketful of fsecal mat- 
ter has been removed. It may lead to peritonitis. It is more com- 
mon in women than in men. It may be relieved by mechanical 
means, but the patient may die from exhaustion. 

Compression from anything outside of the Gut — May pro- 
duce obstruction. It may be from sarcoma of pelvis. It may be 
from tumor of the kidneys or abscess connected with Pott's dis- 
ease, or hydatid cysts of the liver, displaced spleen, etc. Con- 
traction and inflammation of the gut may produce it. Chronic 
peritonitis and tubercular peritonitis with adhesions, retroflexed 
uterus, and enlarged tubes due to pregnancy may cause intestinal 
obstruction (Dennis). 

Symptoms. — 1. Pain which is very severe and is present 
early, is usually referred to the umbilicus, because near this are 
the great solar and mesenteric plexuses. The situation of the 
pain is no criterion to the situation of the obstruction in the early 
stages. Note that continuous pain denotes complete obstruction 
and paroxysmal pain denotes incomplete obstruction, and if the 
pain suddenly ceases it denotes gangrene. There is a localized 
peritonitis. 



INTESTINAL OBSTRUCTION. 291 

2. Vomiting comes on early when the obstruction is in the 
small intestine. The contents of the stomach are first ejected, 
then the biliary secretions, and last stercoraceous material about 
the fifth day. Vomiting usually occurs just after the pain, and 
when suddenly stopping, denotes gangrene. 

3. Constipation is present and continuous. Bowels do not 
move above the constriction. Note the presence of blood in the 
stools. If there is blood, it is likely to be intussusception. The 
blood may come from hemorrhoids. 

4. Abdominal Tenderness is important, but is absent at the 
beginning of the attack. It supervenes quickly, and appears 
about the third day, and is diagnostic as a symptom because it 
points to local peritonitis, and if it is diffused it denotes general 
peritonitis. 

5. There is a tumor or swelling in the abdomen. 

6. The pulse is thready and rapid, 110 to 140 per minute 
and small. 

7. Temperature is subnormal, as a rule; if peritonitis sets 
in it may ris^ to 100° F., and if perforation takes place, it falls 
below normal to 97° F. 

8. Respirations are more frequent, superficial and thoracic. 

9. Anuria. — Urine is scanty and contains albumen and 
indican. 

10. Physiognomy has a haggard expression from mental 
suffering, face is drawn, eyes are sunken, and the intellect is 
good to the end. Collapse finally comes on. 

Caution. — Do not give cathartics, because they will intensify 
the pain, produce more vomiting, increase shock, produce stran- 
gulation, causing perforation and peritonitis. It ma}' convert 
a chronic into an acute, and may induce intussusception. Metalic 
mercury is not much used and should not be till the last. 

Symptoms of Perforation are : 

1. Emphysema of the abdomen, which is sometimes due to a 
gunshot wound or some opening. 

2. Shock, the patient is in collapse. 

3. Condition of the Pulse is diagnostic, on account of 
heart disturbance due to perforation. It is rapid, thready and 
feeble. 



292 A COMPENDIUM OF PRACTICAL MEDICINE. 

4. Tympanitic resonance over the liver. There are two 
conditions of tympanites without perforation, namely : 1. When 
the colon is pushed up and is adherent to the walls; and 2. Em- 
physema of the lower lobe of the lung. The respirations are 
rapid and thoracic in character. 

5. Sudden tympanites at the seat of perforation. 

6. Subnormal temperature. 

7. Vomiting. 

8. Sometimes bloody stools, especially in traumatism. 

9. Retention of urine. 

10. Acute peritonitis and anxious physiognomy (Dennis). 

Treatment. — Give morphine hypodermically. Small doses 
stimulate and large ones paralyze, therefore large doses and not 
small ones are indicated. It relieves intense pain, influences 
shock and relaxes the abdominal walls. It increases the secre- 
tion of urine, affects the pulse, respiration, temperature, and 
vomiting. It arrests peristalsis. Caution. — If it is continued 
too long, retention of the bowels is produced, wdiich is not good. 

Xourislbment. — We cannot nourish by way of the stomach, 
for it is filled with regurgitant fluid, and the intestines are filled 
w r ith gas. Nourish by the rectum and give enema of milk (4 
oz.). We may use hypodermics of brandy. Let the patient 
have ice in his mouth to quench his thirst. It will help to 
control vomiting and keep the tongue moist. 

Local Applications. — Warm ones will relax the abdominal 
muscles. Turpentine stupes over the abdomen is good. Hot 
flannels and poultices are good. Place a pillow under the popli- 
teal space. 

Enemata. — Copious ones in intestinal obstruction are good. 
They must be introduced slowly. If a fountain syringe be used, 
it must be lower than six or seven feet for children, and lower 
than 15 to 18 feet for adults. Warm water with soap-suds and 
olive oil is good. If glycerine is added it will be better. Do 
not use the injection late in the disease, for gangrene will be 
produced. 

Aspirations, or Paracentesis. — Should we aspirate or not ? It 
is dangerous and must not be done only in extreme cases, and 



INTESTINAL OBSTRUCTION. 293 

then must not be done without consultation of some other 
surgeon. 

Operation. — Laparotomy: Results are good when the oper- 
ation is done early, and before the patient is exhausted, and 
before peritonitis sets in. Do not ojjerate if there is suppuration 
with general peritonitis, or if the cause is. some malignant dis- 
ease. First, have the parts thoroughly cleansed with a warm 
solution of bichloride. In the cavity do not use a solution 
stronger than 1 to 10,000, and never use the same sponge twice. 
Always empty the bladder before the operation. Make the in- 
cision in the median line, and the higher we go above the umbil- 
icus the worse it will be, for the gut cannot be easily returned. 
If the ileo-csecal valve is collapsed the obstruction is in the small 
intestine and not in the large. If by bands strangulation is 
caused, cut the bands between the ligatures. If by a slit, through 
which the gut has gone, sew up the slit. If by a false diverticu- 
lum, cut it off, and bring the edges of peritoneum together, and 
let an adhesion form. If by hernia, cut out the damaged gut 
and make an artificial anus. If by volvulus, and it involves the 
ileum, simply untwist it, but if the sigmoid flexure is involved, 
do a left lumbar colotomy. If by intussusception, which occurs 
in childhood largely, and if it affects the small intestine, simply 
draw it out; if that cannot be done, make an artificial anus just 
above the obstruction. Do the operation early. If the obstruction 
is caused by stenosis from ulceration or malignant disease, do a 
laparotomy and remove the disease and make an artificial anus, 
then later on re-establish the contiguity of the gut. If by gall- 
stones, open the gut and remove them or any other foreign 
bodies. If by faecal impaction, it may be removed by manipula- 
tion. If by growth or neoplasm, remove the growth if possible, 
and if not, open the gut. We have sarcoma of the pelvis, tumors 
of the kidneys, mesentery, omentum, and abscess of Pott's dis- 
ease. In chronic peritonitis, wash out the cavity with bichloride 
solution 1 to 10,000. It is successful where there is tuberculous 
disease, but not in carcinoma. In contraction of the mesentery, 
do a laparotomy. If the obstruction is caused by retro-flexed 
uterus, bring it forward. 



294 A COMPENDIUM OF PRACTICAL MEDICINE. 

Laparotomy for Acute Intestinal Obstruction. — The results of 
laparotomy are encouraging. Before the days of aseptic and 
antiseptic surgery, the death rate was 75 per cent.; after that 
time 58 per cent. The percentage of deaths is due to two causes: 
1. Shock. 2. Sepsis. Shock may be diminished by an early 
and rapid operation. Sepsis may be diminished by adhering 
strictly to aseptic and antiseptic surgery. If there is suppuration 
do not operate. Duration of life in acute obstruction of the in- 
testines is six days; so operate early. If laparotomy is done and 
the cause removed, the per cent, of deaths is 56. If the cause is 
not removed the percentage of death is 66. If the gut is gan- 
grenous, and is opened, and afterward sutured, the percentage 
of death is 86 (Dennis). 

PRESCRIPTIONS FOR INTUSSUSCEPTION. 

R Fellis bovini gr. xx. 

Aquae ferventis Oij . — M. 

Sig. : Inject slowly into the bowel until it is fully distended. 
(Knee-chest position is best.) ' — Hawkins. 

R Lobeliae 5ss. 

Aquae bullientis Oj . — M. 

Sig.: Inject one-fourth, or one-half, and repeat if necessary. 

— Bartholow. 

R Extracti belladonnas gr. iv. 

Aquae ferventis Oj . — M. 

Sig. : Inject into the rectum. — Waring. 

R Sodii bicarbonatis g;j. 

Aquae §vj. — M. 

Sig.: Inject into the rectum and follow at once with, 

R Acidi tartarici pulv gr. xxxv. 

A quae g iv. — M. 

Sig.: Inject into the bowel at once after the preceeding. 

— Bartholow. 

IRITIS. 

Is an inflammation of the iris. 

Causes. — Are local and constitutional. It may come from 
functional strain, from injury, from operations, from penetration 
of foreign bodies or by extension of inflammation from adjacent 



iritis. 295 

structures. The constitutional causes are syphilis, rheumatism 
and gout. About fifty per cent of all cases is caused by syphilis. 
Rheumatism aud gout cause obstinate, painful and recurrent at- 
tacks of iritis. In syphilitic iritis, a plastic or gummy exudation 
is thrown out. Gonorrhoea occasionally causes iritis. Other causes 
are malaria, variola, scrofula, and tuberculosis (Noyes). 

Symptoms. — Are objective and subjective. The former are 
change of color of the membrane, abnormal behavior of the pupil 
and injected blood vessels. A blue iris will change to a dull 
gray, a hazel to a dirty brown. The aqueous humor is turbid, 
and the pupil is smoky instead of a clear jet black. The pupil 
will be small and will not respond to light. Adhesions will be- 
come apparent upon dropping a solution of atropia into the eye. 
In severe cases, the whole front of the eye will be intensely red. 
The lids will be imperfectly opened. The subjective symptoms 
will be, impairment of sight, intolerance of light, and pain. The 
pain is first situated in the globe, and is a conspicuous feature 
from the outset, is most severe toward night, or early morning. 
Iritis may attack one eye or both. It generally lasts two to six 
weeks, if neglected it may continue for months, with entire loss 
of sio;ht. 

Sequelce of Iritis are: 1. Adhesions of the iris to the 
capsule of the lens. 2. The exudation may become organized 
and fill the whole pupil, and thus resemble cataract. 3. The 
capsule of the lens may become thickened (Noyes). 

Prognosis. — In simple cases, vision will be perfectly restored, 
but if adhesions take place, sight will be impaired (Noyes). 

Treatment. — Avoid use of eyes, and all sources of irritation. 
The patient must be kept in a dark room. The essential and 
master remedy in iritis is a solution of atropine; it is the begin- 
ning, middle and end treatment. A solution of four grains 
to the ounce must be used and dropped in four to six times daily. 
If poisonous symptoms ajopear from the use of the atropine it 
must be stopped, and the proper treatment instituted. Appli- 
cations of warm water to the eye are useful. For the nocturnal 
pain, hot fomentations are to be used, and morphia administered. 
Constitutional treatment will be necessary in cases of syphilitic, 
rheumatic, or gouty iritis. Gonorrhoea] iritis demands urethra] 



296 A COMPENDIUM OF PRACTICAL MEDICINE. 

treatment. For severe serous iritis with deep anterior chamber 
and much pain, paracentesis will be effectual. When mydriatics 
fail and the pupil is much bound down, iridectomy is the remedy 
(Noyes). 

PRESCRIPTIONS FOR IRITIS. 

J& Atropine sulphatis gr. iv. 

Aquae destillatse ^j. — M. 

Sig. : A drop or two in the eye three times daily. Used with hot 
water, bathing for fifteen minutes every hour till pain is relieved. 

—Chilton. 

R Hy drargyri chlor . corros gr . j . 

Potassii iodidi gj . 

Tinct. calumbse ,^ij. 

Aquse destillatse ad 5yj. — M. 

Sig. : A dessertspoonful in water three times daily. — Lawson. 

R Scopolinse gr. j . 

Aqua? destillatae . : gj . — M. 

Sig.: Two drops into the eye three times daily. — Dunn. 

R Emplastri cantharidis 1 in. by 1 in. 

Sig.: Apply behind the ear, and poultice when blistered. 

— Hartshorne. 

R Duboisiee sulphatis gr. j. 

Aquae destillatae 3j . — M. 

Sig.: One drop into the eye twice daily. — Tweedy. 

ICTERUS. (See Jaundice). 

INSOLATION. ( See Heatstroke ) . 

IODISM. 

If iodine or the iodides are administered in too large doses, 
or to persons of irritable stomach, and for too long a time, they 
will produce gastro- enteric symptoms, headache, giddiness, 
marasmus, sometimes discoloration of the skin, occasionally sali- 
vation, and frequently a wasting of the mammae and testicles. 
This train of symptoms is called iodism. 

Treatment, — Withdraw the drug and give arsenic. Atropine 
is quite effective as a remedy for iodism (Bartholow). 



IRRITABILITY — JAUNDICE. 297 

IRRITABILITY. 

Cause. — All those practices and habits which cause nervous 
strain, and result in nervous exhaustion, may produce irritability. 

Treatment. — Give five grains of chloral two or three times a 
day in irritability with nervousness and restlessness. A sitzbath 
with the water between 60° and 80° greatly relieves fatigue, and 
soothes an irritable restless state of the nervous system. 

ITCHING. (See Pruritis). 

JAUNDICE. 

Called also icterus, is a yellow discoloration of the skin due 
to the presence of bile or blood pigment (Loomis ). Jaundice is 
a symptom common to many affections of the liver. 

Causes. — I. Of Hepatogenous Jaundice. — Duodenal ca- 
tarrh, biliary calculi, inspissated bile and mucus, hydatid 
vesicles, foreign bodies from the intestinal canal, such as stones of 
fruit and round worms, congenital plugging of the duct and cancer 
of the ducts are causes within the duct. The causes which ob- 
struct the duct by external pressure are : Tumors of the pyloric 
extremity of the stomach, of the head of the pancreas and of the 
kidney; pressure from a pregnant uterus, from ovarian and 
fibroid tumors, from omental tumors, from large impaction of 
faeces, from enlarged lymphatic glands in the transverse fissure, 
from waxy cancerous or tubercular change, from abdominal 
aneurism and from hypertrophic cirrhosis of the liver. 

II Causes of Hematogenous Jaundice are : Yellow, 
typhus, typhoid and malarial fevers (Loomis). 

Symptoms. — Jaundice first appears in the conjunctiva, then 
the skin of the face appears sallow or fawn- color. The urine 
early undergoes a change and becomes intensely colored with 
bile-pigment, which it imparts to linen and white paper dipped 
into it. The best test for bile in the urine is the nitric acid test. 
Pour into a test tube an inch of nitric acid, and drop the urine 
slowly on top of the acid. If bile be present, there will be a red 
line next the acid and green uppermost with violet and blue 
between. The stools in jaundice are grayish or slate-colored, 



298 A COMPENDIUM OF PRACTICAL MEDICINE. 

sometimes quite white. Jaundice is usually unaccompanied 
by pain. Headache is a common symptom. There is drowsi- 
ness, hebetude of mind and despondency. In some cases there 
are nausea, a persistent harassing cough, and muscular soreness. 
The temperature in jaundice is usually below the normal. In 
many cases the pulse is slow; more or less itching of the skin; 
sometimes an intolerable itching is observed in many cases. The 
taste is bitter. The vision may be yellow (Bartholow). 

Differential Diagnosis. — The yellow staining is slight in hem- 
atogenous jaundice, but it is more intense in hepatogenous. 
There is great itching of the surface in hepatogenous jaundice 
which is absent in the hematogenous variety. The faeces are 
dark in hematogenous jaundice and white or clay- colored in 
hepatogenous (Loomis). 

Determination of the Cause. — If the jaundice comes on in 
the course of a gastro- duodenal catarrh, it is probably a case of' 
simple catarrhal jaundice. If it occurs in the course of malarial 
fever, it is probably due to malaria. If the jaundice is preceded 
by sudden violent pain in the right hypochondrium, it is due to 
the passage of gall-stones. If the jaundice be persistent — lasting 
many months — and intense, and follow an attack of pain which 
has not been repeated since, it is probably due to a permanent 
occlusion by a gall-stone. If the jaundice be intense, persistent 
and painless with enlarged liver, it may signify obstruction by 
hydatids. A faint jaundice lasting many months, with ascites 
and enlargement of the superficial veins of the abdomen, is pro- 
duced by sclerosis or cirrhosis or nutmeg liver. Jaundice with 
persistent pain or soreness in the right hypochondrium indicates 
cancer (Bartholow). 

Treatment.-— Laxatives and diuretics are useful. Grain doses 
of calomel given at night is the best laxative in these cases. 
Saline laxatives which have a diuretic action are very useful. 
The compound jalap powder is efficient. In malarial jaundice, 
ten to thirty grains each day of quinine is useful. 



JAUNDICE KERATITIS. 299 

RRESCRIPTIONS FOR JAUNDICE. (Catarrhal.) 

R Ammonii chloridi gss. 

Ext. taraxaci fiuidi ^iij. — M. 

Sig. : A teaspoonful three times daily. — Bartholow. 

. R Ext. hydrastis fiuidi gj. 

Sig.: Ten drops before meals for some weeks. — Bartholow. 

R Sodii phosphatis §ij. 

In pulv. no. xvi. div. 
Sig. : A powder every four hours. — Bartholow. 

R Ammonii iodidi 5j- 

Liq. potassii arsenitis 3ss. 

Tinct. calumbse Iss. 

Aquae Siss. — M. 

Sig.: A teaspoonful before meals. — Bartholow. 

KERATITIS. (Phlyctenular). 

Is an inflammation of the cornea. It is characterized by 
one or more slight elevations of a grayish-white or yellow color, 
which are about the size of a pin head. Sometimes they are 
visicles and sometimes semi -solids, and soon their summit is 
eroded, leaving a little ulcer (Noyes). 

Symptoms. — Are subjective and objective. There will be 
hyperemia, severe pain, photophobia and lachrymation. It is 
especially a disease of children, and attacks the ill -fed or over- 
fed, the weakly and the dirty. There is usually eczema of the 
head or face. In bad cases the cornea may be perforated 
(ISFoyes). 

Causes. — Are scrofula, gout, syphilis, malaria, eczema, 
herpes, struma and exanthematous diseases. 

Treatment. — Must be both local and constitutional. If there 
be only one or two eruptious, and they recent and situated on the 
cornea, they may be scraped out clean by a sharp spud. Then tie 
up the eye, and wash it out ouce in three hours with a two per 
cent solution of boric acid. Instead of the scraping, the ointment 
of yellow oxide of mercury, gr. ij. to dr. j. may be rubbed well into 
the eye once daily. If there is an iritis along with the keratitis, 
a solution of atropine may be dropped into the eye thrice daily. 
The chief remedy against photophobia is cocaine which may be 



300 A COMPENDIUM OF PRACTICAL MEDICINE. 

used several times daily. Cold water and boric acid will be 
grateful. The constitutional and hygienic measures are never to 
be neglected. Cleanliness, pure air, exercise and a suitable diet 
will be needed. Mild purgatives as rhubarb and soda are some- 
times useful. Cod-liver oil and the syrup of the iodide of iron, 
are standard remedies (Noyes). 

PRESCRIPTIONS FOR KERATITIS. 

Jfc Atropinse sulphatis gr. ij. 

Aquae destillatse §j. — M. 

Sig. : One or two drops into the eye three times daily. 

— Bartholow. 

jfc Hydrarg chloridi corrosive gr. j. 

Aquse destillatse §iv. — M. 

Sig.: Apply as a bath to the eye by means of a reservoir eye- 
cup. — Grandmont. 

KIDNEY=DISEASES, (See Albuminuria, Bright's Disease and 

Uraemia.) 

KINGS'=EVIL ( See Scrofula. ) 

KNEE=JERK. 

In most healthy individuals a vigorous contraction of the 
quadriceps extensor muscle is produced by striking quickly with 
the ulnar side of the hand, the ligamentum jDatellas when the leg 
is flexed and the muscles are relaxed. This contraction is called 
the knee-jerk, or patellar reflex, and may be increased, dimin- 
ished or abolished in certain diseases of the spinal cord. The 
centre for the patellar reflex is in the gray matter of the lumbar 
portion of the spinal cord. Disease of the gray matter in this 
situation, and of the posterior columns of the lumbar enlarge- 
ment, cause the patellar reflex to disappear. In various condi- 
tions causing spastic paralysis, the patellar reflex is increased. 
In posterior spinal sclerosis, knee-jerk is absent; it is also absent 
in disease of the anterior cornua. Knee-jerk is absent in many 
cases of diphtheria from the very first day of the illness (Flint). 



LABOR. 30 I 

LABOR. 

Is the expulsion of the foetus from the uterus. Normal labor 
occurs when the foetus is mature. 

The Pains of Labor. — The pains of labor are first felt over 
the sacrum, and radiate to the rectum, bladder, across the abdo- 
men and down the thighs. At first the pains are dull, but 
finally reach the point of supreme agony. 

Stages. — There are three stages of actual labor: 1. The 
stage of dilatation of the cervical canal. 2. The stage of expul- 
sion of the child. 3. The stage of placental delivery (Lusk). 

Duration of Labor. — The average for primiparse is seventeen 
hours, for multiparas twelve hours. For the after-pains the fol- 
lowing prescription of Witherstine may be used: 

gr Morphia sulphatis gr. ij. 

Aquae camphorae ^ij. — M. 

Sig. : A teaspoonful every three hours. 

Leishman's formula may be used for precipitate labor: 

j& Morphiae sulphatis gr. j.-ij. 

Olei theobromae 3ij. — M. 

Ft. massa et in suppositoria no. iv. div. 
Sig.: One as required. 

In retained placenta, Atthill's formula is useful: 

{& Tinct. nucis vomicae 3j. 

Ext. ergotae fluidi gvi. 

Elixir simplicis ad §vi. — M. 

Sig.: A teaspoonful in a wineglassful of water every three hours. 

In hour-glass contraction of the uterus, Barnes gives three 
to five drops of amyl nitrite to be inhaled from a handkerchief. 
In protracted labor due to rigid os, Ringer gives the fol- 
lowing: 

|& Morphiae sulphatis gr. ij. 

Aquae des tillatae 3J . — M. 

Sig.: Five or ten minims hypodermically, repeated as necessary. 

In protracted labor from atony of the uterus, Leishman 
gives the following: 

j& Extracti ergotae fluidi 5]. 

Olei gaultheriae gtt. iv. — M. 

Sig.: A teaspoonful every four hours, only if os is dilated, and 
soft parts not rigid. 



302 A COMPENDIUM OF PRACTICAL MEDICINE. 

LARYNGISMUS STRIDULUS. 

Called, also, spasm of trie glottis, internal convulsions, child 
crowing, etc., is spasm of the muscles of the larynx. 

Violent emotion, especially anger, may induce a temporary 
suspension of respiration in young children. In the midst of 
their crying, they suddenly hold their breath, but it is not fol- 
lowed by a stridulous inspiration as it is in true spasm of the 
glottis (Smith). 

Causes. — Laryngeal spasm is most frequently met with in 
children, when indigestion, teething and impressions of external 
cold are usually assigned as causes. Cerebral irritation is given 
as a cause. Scrofulous and cachectic children are said to be es- 
pecially subject to spasms of the glottis (Loomis). 

Symptoms. — There is generally previous ill-health. The at- 
tacks are more frequent and severe at night, in or after the first 
sleep, than in the day. A peculiar crowing sound is heard now 
and then during inspiration especially when the child is crying. 
In severe paroxysms respiration often ceases entirely for a mo- 
ment. The face becomes livid. The duration of the paroxysm 
may be a quarter, a half, or even a whole minute. The parox- 
ysms may occur almost daily for several weeks (J. L. Smith). 

Treatment. — During a paroxysm it is customary to employ 
means to produce a strong impression on the surface, as slapping 
the back or sprinkling cold water on the face. A ready and 
effective mode of arresting a paroxysm is to introduce a finger 
into the throat. If the stomach is overloaded an emetic is indi- 
cated. Employ a hot foot-bath, and warm fomentations to the 
neck. Laxatives should be given. From ten minims to one 
drachm of paregoric often arrests the paroxysm (Bartholow and 
Flint). 

PRESCRIPTIONS FOR LARYNGISMUS STRIDULUS. 

B Syrupi ipecac ,^ij. 

Sig. : A teaspoonful every ten or fifteen minutes until free emesis 
occurs. — Bartholow. 

R Chloroformi gj . 

Sig. : A few drops inhaled from a handkerchief. — Bartholow. 



LARYNGITIS. 303 

R Tinct. aconiti rad gss. 

Sig. : One drop in a teaspoonful of water every hour for three 
doses, then every two hours. — Ringer. 

LARYNGITIS. (Acute and Chronic.) 

Is an inflammation of the mucous membrane of the larynx. 
It may occur at any age. There is an acute and chronic form of 
the disease. 

Causes. — Acute catarrhal laryngitis is caused by atmospher- 
ical changes, by exposure to wet and cold and by chilling of the 
surface, especially of the neck and feet. " Taking cold' 1 is a 
fruitful cause of laryngitis. Anything that irritates the laryn- 
geal mucous membrane may produce a laryngitis (Loomis). 

Symptoms. — Usually at first there is soreness of the throat, 
accompanied by a sense of constriction, or a tickling sensation 
with a tendency to cough; the larynx is tender on pressure, there 
is difficulty in swallowing. The expectoration is at first tena- 
cious; later it may become thick, purulent and abundant. The 
voice is hoarse or is reduced to a whisper. The face is flushed, 
the skin hot and dry, there is fever and a frequent pulse 
(Loomis). 

Treatment. — The patient should be confined to bed. The 
air of the apartment should be kept moist by vapor of water. 
Tincture of aconite root — one drop for a child and two drops for 
m adult every two hours — is highly efficient. If there be much 
cough, two to iive drops of the deodorized tincture of opium and 
one or two drops of the fluid extract of ipecac may be given to- 
gether. A spray of a solution of morphia to the throat is an 
excellent means of relieving cough. A very minute quantity of 
tartar emetic, with paregoric and syrup of lactucarium is also an 
efficient combination. A hot or cold pack should be wrapped 
about the throat, after a brief application of mustard; and if the 
■case is just beginning the feet should be placed in a hot mustard 
foot-bath. 

Prophylaxis. — Those who have frequent attacks should wear 
flannels, and protect the feet against dampness. Avoid furs 
about the throat. The tendency to take cold may be obviated 
by a daily morning cold sponge-bath. The access of an impend- 



304 A COMPENDIUM OF PRACTICAL MEDICINE. 

ing attack may be prevented by a full dose of quinine and mor- 
phine (15 grs.-gr. J to i) (Bartholow). 

Causes of Chronic Laryngitis. — It maybe a sequel of acute 
laryngitis. It may occur from constant use of the voice in public 
speaking or singing. It constitutes the chief morbid condition 
in what is termed "clergyman's sore throat. 7 ' It is frequently 
secondary to chronic nasal catarrh. It most frequently occurs as 
an accompaniment of other affections, as syphilis and pulmonary 
phthisis (Loomis). 

Symptoms. — Of chronic catarrhal laryngitis are local. In 
some the voice is hoarse and husky; in other cases, the patient is 
only able to speak in a husky whisper. There is a hoarse strid- 
ulous cough, with more or less abundant muco- purulent expect- 
oration frequently streaked with blood and of a fetid odor. In- 
spiration and expiration are often accompanied by a whistling or 
stridulous sound. In some cases the act of swallowing fluids or 
solids excites spasm of the glottis. Talking is very fatiguing. In 
the morning the most severe paroxysms of coughing and strain- 
ing are experienced : the secretion accumulates during the night, 
and is detached with difficulty, so that much coughing, hawking 
and straining are necessary (Loomis and Bartholow). 

Treatment. — -Mild astringent solutions of alum, perchloride 
of iron, tannin or sulphate of zinc, from one to twenty grains to 
the ounce of water may be used. For steam inhalations, a few 
drops of oil of creosote, oil of pine or oil of juniper, added to 
half a pint of water at a temperature of 150° F., maybe employ- 
ed. The spray and steam inhalations may be repeated three 
times daily. A solution of carbolic acid (two grains to an ounce 
of water) as a spray, may be used with benefit in cases where 
the laryngeal secretion has a fetid odor (Loomis). The treat- 
ment of chronic catarrhal laryngitis of phthisis and syphilis is 
the same as in simple chronic laryngitis, with the constitutional 
treatment of those affections added. 



LARYNGITIS — LEAD POISONING. 305 

PRESCRIPTIONS FOR LARYNGITIS, 

R Sodii biboratis gr. viij. 

Aqure 3 ij • 

Aquae cologniensis gtt. x. — M. 

Sig. : Use frequently with atomizer as a spray (chronic form). 

— Sajous. 

R Potassii permanganatis gr. ij. 

Aquoe destillatse §ij. — M. 

Sig.: Use with atomizer several times daily. (In fetid variety 
of chronic laryngitis). — Sajous. 

R Tinct. aconiti radicis Sss. 

Sig. : One drop in water every hour. When it has existed some 
days then give the following: 

R Vini mariani Oj. 

Sig. : A wineglassful every three hours, with absolute rest of 
voice. (In acute laryngitis). — Sajous. 

LEAD POISONING. 

Is a morbid condition produced by the introduction of the 
salts of lead into the system, either through the mucous surface 
or the skin (Loomis). 

Causes. — The sources of lead-poisoning are numerous. 
Painters and workers in lead are those most frequently affected. 
Drinking water, wines, and ales often become impregnated with 
it. The application of lead powder as a cosmetic to the face and 
neck has caused lead- poisoning. Some persons are more suscep- 
tible to its poisonous influence than others. Lead taken as a 
medicine, a dressing for the hair containing acetate of lead, a lo- 
tion for the eye, and vaginal injections containing lead may pro- 
duce lead-poisoning. Lead may be inhaled in sufficient quanti- 
ties to produce lead -poisoning, as in paper staining, grinding of 
colors, plumbing, shot-making, etc., lead-poisoning has re- 
peatedly occurred from sleeping in newly-painted rooms. Soda- 
water may contain lead, and articles enclosed in lead foil may 
produce poisoning. Children may be poisoned by sucking lead 
toys (Flint and Loomis). 

Symptoms. — In chronic lead -poisoning, the general health is 
impaired. The skin becomes sallow, dry and harsh. There arc 



306 A COMPENDIUM OF PRACTICAL MEDICINE. 

dyspepsia, loss of appetite, and constipation. A blue line forms 
along the edge of the gums adjoining the teeth. The most im- 
portant symptom is intestinal colic. It has been called painters' 
-colic, plumbers' colic, colica pictonum, and dry bellyache. 
Pain is oftenest referred to the region of the umbilicus. It is 
& dull aching pain, sometimes acute. Patients are inclined to lie 
upon the belly with a folded pillow placed under them over the 
seat of pain. There may be nausea and vomiting. Hiccough 
and eructations of gas are common. The urine is scanty, and 
micturition is sometimes difficult and painful. There is no fever. 
The most frequent of the nervous affections is drop -wrist from 
paralysis of the extensors of the forearm. There is no loss of 
■sensation in the paralyzed limb. The diagnosis can be made by 
the history of the case, and from the symptoms (Flint and 
Xoomis). 

Treatment. — Remove the patient from all sources of lead- 
poisoning. The bowels should be kept freely open. Five to ten 
grains of iodide of potassium three times daily should be given. A 
drachm of dilute sulphuric acid in a quart of sweetened water may 
be taken in twenty-four hours. Faradization for ten or fifteen 
minutes three times a day for two or three months is the only 
effectual remedy for restoring the paralyzed muscles. Chloro- 
form given by the mouth and applied over the abdomen some- 
times acts promptly and efficiently in relieving the pain. Opium 
in some form may be required to relieve the pain. The warm 
bath is useful as a palliative soothing measure (Flint and 
Loomis). 

PRESCRIPTIONS FOR LEAD=P0IS0NINQ. 

R Magnesii sulphatis %]. 

Acidi sulphurici dil 3j. 

Aqua) ^iv. — M. 

Sig. : A tablespoonful three times daily, preceded by five to tea 
grains of potassium iodide. — Brunton. 

R Morphia) sulphatis gr. iv. 

AquaB destillatse --Sij- — M. 

Sig.: Five to ten minims hypodermically repeated every fifteen 
minutes till relieved. — Bartholow. 



LEPROSY. 307 

R Pulv. opii gr. xij. 

Ext. belladonnse gr. ij . 

Oleitiglii gtt. xij.— M. 

Ft. massa et. in pil. no. xii cliv. 
Sig. : A pill every two hours until relieved. — Loomis. 

LEPROSY. 

Is an infectious and contagious disease of very ancient date, 
characterized by nodules which occur most frequently in the 
skin. 

It has been endemic in Egypt, India and China. It was 
prevalent among the Hebrews. 

Leper houses, for the isolation of the diseased, were estab- 
lished in the seventh century. There was an intense dread of 
the disease, and lepers had to wear a special costume, usually a 
long gray gown with a hood drawn over the face; they carried a 
wooden clapper to give warning of their approach. They were 
not allowed to enter churches, inns, mills or bakehouses, nor to 
touch healthy persons, nor to eat with them, nor to wash in the 
streams, nor to walk in narrow foot paths. A leper woman, 
quick with child, was buried alive. Leprosy is still common all 
over the east, and there are leper villages in China, Japan, Persia 
and Crete. The disease is also common in Africa, India, Mada- 
gascar, St. Helena, Maderia, Canaries, Azores, West Indies, 
Mexico, Brazil, Central America, Norway and the Hawaiian 
Islands. Sporadic cases occur in England and France. 

Causes. — It is an hereditary disease, and there is the strong- 
est repugnance to marriage into a family where leprosy is known 
to exist. It is an infectious and contagious disease. It never 
originates cle novo. The lesions of leprosy contain characteristic 
bacilli which would seem to be the real cause. Climate, poverty 
and bad hygiene are predisposing causes (Anderson). 

Symptoms. — Leprosy appears as a constitutional disease, 
marked externally by the deposition of a peculiar albuminous 
substance in the skin, appearing as discolored patches and no- 
dules, and effecting the nerve centres and peripheral nerves. 
Leprosy has been divided into two forms, viz: the tuberculous 
and the anaesthetic. The tubercular is characterized by (lis- 



308 A COMPENDIUM OF PRACTICAL MEDICINE. 

colored patches and nodules, and the anaesthetic by 
depositions in the nerve centres. After an uncertain 
prodromal stage, there will appear successive out- 
breaks of the eruption, in the form of blotches on the skin,, 
which come and go before tubercles make their appearance. The 
tubercles appear on the site of the patches. When the tubercles 
are fully formed, they are brown and the skin is thickened, and 
the hyperesthesia is succeeded by anaesthesia. Sometimes there 
is an irregular thickening of the entire skin of the face. Tuber- 
cles are most frequently developed on the head, face, ears, nose, 
extremities, the mammary gland and nipple, the scrotum and 
around the anus and vagina. There is but little pain in this 
stage of the disease. The tubercles are extremely apt to ulcerate 
from personal uncleanliness, and then the odor of the patient is 
extremely offensive. Ulceration most frequently commences at the 
tips of the ears, then at the toes and fingers, and it often termi- 
nates in necrosis, the fingers and toes dropping off joint by joint 
leaving a well healed stump. Ulceration and sloughing may 
take place with but very little pain. In about nine years the 
disease reaches its climax, the whole system is poisoned, and the 
patient presents an aspect the most loathsome that can be im- 
agined. The natural duration of the disease is about fifteen 
years (Anderson). 

Treatment. — The disease is incurable, and the treatment is 
merely palliative. To cure the disease the ancient kings of 
Egypt bathed in the blood of slaves. The Hindoos, drank cows' 
urine. Chaulmoogra oil and Grurjon oil are the best remedies 
known for leprosy. 

LEUCOCYTH^EMIA. 

Called also leucaemia, is a disease characterized by the 
enormous increase of the white corpuscles of the blood, accom- 
panied by enlarged spleen and enlarged lymphatic glands 
(I>artholow). 

Causes. — The real cause of this malady is unknown. It 
occurs at all ages and conditions, but is most frequent between 
thirty and forty-five. It is twice as frequent in men as in women. 
In women there seems to be a connection between the generative 



LEUCOCYTH^EMIA. 309 

organs and this disease. Cold, wet, and all anti-hygienic condi- 
tions predispose it. The morbid alterations begin in the spleen, 
then attack the lymphatic glands, then the marrow of the bones 
and finally become general (Bartholow and Loomis). 

Symptoms. — Leucocythaemia develops gradually. There is 
usually a history of the gradual appearance of weakness, mental 
and physical anaemia, ringing in the ears, vertigo and palpita- 
tion. The patient becomes pale and assumes a waxy appear- 
ance. In about eighteen months, the ansemia becomes profound, 
the lymphatics of the neck, groin, or other superficial parts are 
found to be somewhat enlarged. The spleen is also enlarged. 
There are dyspnoea and at times profuse sweating, feverishness 
toward evening, rapid pulse, oedema of the ankles and puffiness 
of the eyelids. The least cut bleeds severely. A soft blowing 
murmur — anaemic murmur — is heard at the base of the heart. In 
leucocythaemia the blood is paler than normal. The contrast is 
nicely shown, when a drop of the blood is compared with a drop 
of healthy blood, on a piece of white linen. In this disease 
there is one^vhite corpuscle to six of the red. There is consti- 
pation at first, and finally diarrhoea persists. It is a chronic 
malady, and the average duration of the whole disease is two 
years (Bartholow and Loomis). 

Prognosis. — All cases are fatal. 

Treatment. — Must be symptomatic, as we have no specific 
for this disease. Quinia, iron and ergotin can be given together 
in pill form; five grains of quinia, one grain of reduced iron, and 
two grains of ergotin should be administered three times a day. 
Electricity should be applied to the splenic region. Good results 
are obtained from the local application of the ointment of the 
biniodide of mercury to the splenic region. The ointment should 
be rubbed in daily, before a bright fire, until the skin begins to 
vesicate, then discontinued for a few days. As the blood is im- 
poverished in this disease, careful alimentation is of the greatest 
importance. Fats, starches and sugars should be excluded from 
the diet, and the patient fed on fresh meats, milk, eggs and fish. 
Pepsin and muriatic acid should be administered after each meal. 
Fowler's solution, and the compound syrup of the hypophos- 
phites may be given with benefit (Bartholow). 



310 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR LEUCOCYTH/EMIA. 

R Acidi nitro-muriatici dil |j. 

Sig. : Ten to twenty drops in a wineglassful of water thrice daily. 

— Hartshorne. 

R Quinise sulphatis 3J. 

Ferri sulph. exsiccat ^iss. — M. 

Ft. massa et in pil. no. xxx. div. 
Sig.: Four or five pills daily. — Bartholow. 

LYMPHADENOMA. 

Called also Hodgkin's disease, because it was first described 
by Dr. Hodgkin in 1832; known also as pseudo-leucocythaemia 
or leukaemia, is a disease characterized by enlargement of the 
lymphatic glands and spleen, and by progressive anaemia, but 
without an increase of white corpuscles in the blood (Bar- 
tholow). 

Causes.— Are unknown. It is not hereditary. It may come 
on in a person in apparently perfect health; it is more common 
in men and in youth and old age than in the middle period of 
life; but it may occur at any age (Bartholow). 

Symptoms. — The lymphatic glands in the neck, armpit or 
groin are first attacked, and become greatly enlarged. Unlike 
scrofulous glandular enlargement they undergo no caseation, 
suppuration or retrogressive changes. All the lymphatics of the 
body may be enlarged. The spleen is enlarged. Emaciation 
and ansemia aie marked and progressive. There may be dull 
pains from pressure on the sensory nerves. The pulse is small 
and rapid. There is usually fever in the evening. The number 
of white corpuscles in the blood is not in excess of the normal in 
the majority of cases. The course of the disease is chronic. One 
year is its average duration; two months and three years are its 
extremes (Bartholow and Loomis). 

Differential Diagnosis. — Lymphadenoma may be mistaken for 
leucocythsemia. In leucocythaemia the changes in the glands 
succeed to those in the blood, whereas the glandular enlarge- 
ment is first in Hodgkin's disease. By microscopic examination, 
when the ratio between the white and red corpuscles reaches one 



LYMPHADEXOMA LEUCORRHCEA. 311 

to twenty the case must be regarded as one of leucocythaemia 
(Bartholow and Loomis). 

Prognosis. — Is bad. 

Treatment. — Fowler's solution increased to ten, fifteen or 
twenty minims, thrice daily, according to the forbearance of the 
stomach seems to be effective; and one to five minims in distilled 
water may be injected into the enlarged glands. Iodide of po- 
tassium may be tried. The syrup of the iodides of iron and 
manganese has seemed to do good. Cod- liver oil is useful as a 
nutrient and tonic (Bartholow). 

LEUCORRHCEA. 

Is a morbid alteration and exaggeration of the physiological 
uterine and vaginal secretions. In a state of health these parts 
secrete in small quantity a mucous liquid which always contains 
a few leucocytes. As soon as this has become abundant and 
purulent, it is morbid and constitutes a leucorrhcea. Leucorrhcea 
is also called ivhites, and is a catarrhal condition of the vagina 
and uterus. 

The purulent discharge may be from two sources, the uterus 
or the vagina. Vaginal leucorrhcea may often be found alone; it 
may be a discharge of very thin fluid of a milky appearance, 
which does not stain the linen much, or it may be charged with 
pus and be of a greenish -yellow color; its reaction is acid. Leu- 
corrhcea from the body of the uterus is of a somewhat viscid 
nature; that from the cervix is jelly like and in the normal state 
is transparent, like the unboiled white of egg^ staining the linen 
strongly; in disease it is of a greenish-yellow color. Its reaction 
is alkaline. The leucorrhceal secretion is constantly produced, 
but is voided a little at a time. 

Causes. — Leucorrhcea may depend simply on a general de- 
bilitated condition, as anaemia, chlorosis, etc. This symptomatic 
form is so frequent that Marc d'Espine has claimed to find it in 
two-thirds of the women. 



312 A COMPENDIUM OF PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR LEUCORRHCEA. 

R Aluminis 3j. 

Zinci sulphatis ^ss. 

Sodii biboratis gr. iv. 

Aquae rosse ^viij . — M. 

Sig. : Use as injection. — Bartholow. 

According to Bartholow, uterine and vaginal leucorrhcea, ul- 
cerations, and erosions of the cervix uteri, are quickly improved 
by the topical application of the fluid extract of hydrastis, 
which may be used in an undiluted state. The same author 
knows of no more effective application in leucorrhcea than tan- 
nin and iodoform applied in the dry way, well packed around 
the cervix uteri. Carbolic acid diluted and used with care is an 
excellent deodorizer when the discharges from the vagina are 
fetid. According to Ringer, a drachm of bicarbonate of potash, 
soda, or alum to a pint of water is a useful injection to check 
leucorrhcea, when this discharge depends on an increased secretion 
of the glands of the os uteri. The alum solution constrings the 
parts, and sometimes causes severe cramp-like pains. 

PRESCRIPTIONS FOR LEUCORRHCEA. 

R Acidi tannici ,^iv. 

Glycerinae ^x vj . — M. 

Sig.: A tablespoonful into a quart of tepid water, used as a va- 
ginal injection for five minutes, night and morning. — T. G. Thomas. 

R Sodii bicarbonatis ,. 5j. 

Tinct. belladonnas ^ij. 

Aquae Oj . — M. 

Sig.: Use as a va_inal wash. — Ringer. 

R Tinct. sulphatis. 

Aluminis sulphatis aa 3iss. 

Gly ceri nse §vj . — M. 

Sig.: A tablespoonful to a quart of water, as a vaginal injection. 

— Thomas. 

R Acidi boracici 5j. 

Aquae ferventis Ovj. — M. Ft. lotion. 

Sig. : To be used as a vaginal injection. — Ringer. 



LICE. 313 

R Potassii permanganatis 3ss. 

Aquae ^xv. 

Sig. : For vaginal injection. In fetid discharge. — Bartholow. 

R Sodii biboratis H i j - 

Sig.: A teaspoonful to a pint of water as a vaginal wash. For 
leucorrhcea of pregnancy. — Parvin. 

R Potassii chloratis gij. 

Sig.: A teaspoonful to a pint of water as a vaginal injection. 
(In simple cases.) — Parvin. 

LICE. 

There are three varieties of this affection, each dependent 
npon a separate parasite, namely : 1. The pediculns corporis, 
which is met with exclusively upon non-hairy parts. It secretes 
itself among the folds of the clothing, and is rarely seen upon 
the body except when feeding. 2. The pediculus capitis, which 
is met with exclusively upon the head. And 3. The pediculus 
pubis, which is met with on all hairy parts except the head, but 
the hair on the pubis and neighboring parts is its favorite hunt- 
ing ground. The crawling and biting of these parasites produce 
irritation and itching, to relieve which the part is scratched 
(Anderson). 

Treatment. — Is very simple. The most effectual remedies 
are carbolic acid, sulphur, mercury, staphisagria, sabadilla and 
pyrethrum, the essential oils and alcohol. The following for- 
mulae are good : 

R Acidi carbolici gij. 

Spts. rosmarini 3j . 

Spts. rectificati gss. 

Aqua? destillatae ad § vj . — M. 

Sig. : Sponge the affected parts night and morning. — Anderson. 

R Hydrargyri perchloridi gr. xij. 

Spts. rectificati Jj. 

Aquae destillatae %v. 

Olei rosae IHj.— M. 

Sig.: Sponge the affected part night and morning. — Anderson. 

R Pulv. staphisagriae 3J. 

Adipis 5iv. 

Olei rosmarini gtt. xxx. — M. 

Sig.: Apply once daily. — Anderson. 



314 A COMPENDIUM OF PRACTICAL MEDICINE. 

LICHEN. 

Is a papular inflammation of the skin. It consists of minute 
conical papulae, generally of reddish color, and occurring in 
clusters. It is most frequently encountered in the summer 
months and in adults, and often in persons who are in good 
health, but who have been exposed to much fatigue or anxiety. 
Disordered digestion may produce it. It is commonly chronic 
(DaCosta). 

Treatment. — Arsenic sometimes relieves lichen and other 
obstinate skin affections (Ringer). Cantharides is useful in 
lichen. An ointment composed of half a drachm of chloroform 
to an ounce of lard will often allay the itching of lichen or of 
urticaria. Patches of obstinate lichen and psoriasis, especially 
of the hands, even when not syphilitic, will sometimes yield to 
mercury treatment. The calomel and nitrate of mercury oint- 
ment may be mixed, and the addition of tar ointment sometimes 
increases the efficacy of this combination (Ringer). In lichen 
psoriasis, eczema, ichthyosis, urticaria, prurigo and scabies and 
the warm bath may be employed with much benefit. 

PRESCRIPTIONS FOR LICHEN. 

R Cretan prseparatse 3vi. 

Sulphuris sublimati 

Olei cadini — aa -Six. 

Saponis nigris 

Adipis — aa gxx v. 

(Melt the lard and then add other ingredients.) 
Sig. : Apply locally. — Hebra. 

R Sodii arseniatis gr. iss. 

Aquas destillatse .5xxv. — M. 

Sig. : A teaspoonful every morning at meal time. — Vidal. 

B Glyceriti amyli 3 v. 

Pulv. acidi tartarici gr. xv. — M. 

Sig.: Apply locally. — Vidal. 



LOCOMOTOR ATAXIi. 315 

LOCOMOTOR ATAXIA. 

Called also Duchenne's disease, known also as posterior 
spinal sclerosis, tabes dorsalis, gray degeneration of the posterior 
columns, and leuko- myelitis posterior chronica, is one of the 
most frequent diseases of the spinal cord, and is a form of myel- 
itis which does not extend transversely, but longitudinally, and 
is limited to the posterior columns (Bartholow). 

Causes. — An inherited tendency is probably the chief cause. 
It occurs between twenty and sixty, but is most frequent between 
thirty -five and fifty. It attacks males six times as often as 
females. Exposure to cold and dampness, fatigue and depress - 
ing moral emotions favors its development. Sexual excesses, 
rheumatism, sy23hilis, excessive use of tobacco and blows on the 
spine are predisposing causes (Bartholow and Loomis). 

Symptoms. — The distinctive characteristic of the affection is 
impairment or loss of the ability to combine and direct volun- 
tary muscular movements. 

Stages. — 1. The initial period or first stage. 2. The ataxic 
period, or second stage. And 3. The paralytic or third stage. 
During the first stage or period, there are sharp, tearing, light- 
ning pains in the lower limbs, clysuria, incontinence, spermatorr- 
hoea, nocturnal pollutions, excitement of, or loss of sexual desire, 
a sense of weariness in the limbs and nausea and vomiting, at- 
tended by severe and paroxysmal aching in the stomach. A 
sense of numbness and formication in the limbs is common in this 
period. There may be a girdle sensation, not only about the 
waist, but also in the limbs — chiefly about the knee and ankle. 
Rectal and urethral colic are frequent. The pains during this 
period are usually in the feet and legs, but they may have their 
seat in the back, stomach, intestine or bladder. At first they do 
not come on often, and are of short duration. The muscles of 
the eyes may be affected, causing double vision, or strabismus, 
which may last a few days, and then disappear. Sometimes the 
patient will complain of a sensation of some soft substance be- 
tween the feet and the ground. One portion of the surface may 
be anaesthetic, another hyperaesthetic. The pupil on one side 
may be contracted to the size of a pin's point, showing paralysis 



316 A COMPENDIUM OF PRACTICAL MEDICINE. 

of the sympathetic, and on the other side dilated. Oftener both 
pupils are contracted. A symptom which possesses considerable 
diagnostic value is the absence of contraction of the pupil on 
exposure to light, while there is normal contraction in the acts 
of accommodation; this is called the "Argyll-Robertson pupil." 

The "Knee- jerk, '■' or patellar tendon refiex, is found to be 
absent in 76 per cent, of the cases, according to Buzzard. The 
duration of this stage varies from a few months to several years, 
and then begin the symptoms characteristic of the second or 
ataxic stage. The ataxia is generally first manifested in the 
lower extremities. The legs are thrown forward with a quick, 
jerking movement, and the feet are brought to the ground on 
the heels with force and are liable to strike against each other. 
The patient is unable to button or unbutton clothes, when the 
upper extremities are affected. There may be double vision and 
night-blindness. A symptom even when the affection is slight, 
is inability to stand with the feet in apposition and the eyes 
closed. The patient's eyes are directed to the feet and ground 
in walking. Impotence occurs in this stage. The patellar 
reflex is wanting and this is diagnostic. Cutaneous sensibility 
is more or less impaired. During this period the joints some- 
times rapidly swell. In the third or paralytic stage, notable 
paralysis is added to the ataxia. The muscles waste, the patient 
falls into a cachectic state, cystitis and bed-sores occur, and 
death takes place from exhaustion. During this third stage, 
there is always complete impotence, and loss of sensation about 
the rectum. Locomotor ataxia is a non-febrile disease. The 
whole duration of the disease is on the average seven years, but 
may continue thirty years. The shortest duration is three years 
(Bartholow, Flint and Loomis). 

Differential Diognosis. — Locomotor ataxia may be confounded 
with paraplegia, multiple cerebro- spinal sclerosis, cerebellar dis- 
ease, chronic myelitis, and chronic spinal meningitis. In para- 
plegia, there is true paralysis; the limbs merely dragged in walk- 
ing; there is no resistance to artificial movement; the nutrition of 
the muscles is greatly impaired; neuralgic pains are absent, and 
there are no ocular symptoms. In ataxia these symptoms are re- 
versed. In multiple cerebro- spinal sclerosis, there are a peculiar 



LOCOMOTOR ATAXIA. 317 

shaking tremor, impairment of voice and speech, and nystagmus. 
In ataxia these symptoms are absent. In ataxia there are iron 
band sensations, bladder symptoms, the lightning-like pains and 
the heel walk, all of which are absent in the former disease. In 
cerebellar disease there is vertigo. The patient can stand and 
walk better with his eyes shut than open. There is absence of 
neuralgic pains; and headache, vomiting and convulsions are 
prominent symptoms. In ataxia this is not so. In chronic 
myelitis there are no disorders of co-ordination. In chronic 
myelitis the limbs are dragged, and the ocular symptoms are ab- 
sent. The reverse in ataxia. In meningitis there is pain in- 
creased on pressure, slight paralysis, but no inco- ordination, and 
no ocular symptoms (Loomis). 

Prognosis. — Unfavorable. 

Treatment. — About one grain a day in divided doses of 
nitrate of silver is recommended. The galvanic current is nearly 
always of service. Some cases will be benefited by the iodides, 
others by the bromides. Strychnine, phosphorus, arsenic, the 
chlorides of gold, sodium, and barium, belladonna and ergot all 
have been recommended. The patient should remain at rest and 
not expose himself to cold or wet, and should wear flannel next 
the skin. Coffee, tea, tobacco and alcoholic stimulants should 
be given up. Cold water baths are favorable (Bartholow and 
Loomis). 

PRESCRIPTIONS FOR LOCOMOTOR ATAXIA. 

R Ext. physostigmatis gr. x. 

Ext. gentianse gr. xL. — M. 

Ft. massa et in pil no. 100 div. 
Sig. : One pill every three hours. — Murrell. 

R Antifebrin 3J . 

In pulv. no. xv. div. 
Sig. : One powder every half hour for two doses, then every four 
hours. 

R Strychnise sulphatis ...gr. iss. 

Syr hy pophosphiti sxij . — M. 

Sig.: A teaspoonful thrice daily. — DaCosta. 



318 A COMPENDIUM OF PRACTICAL MEDICINE. 

LUMBAGO. (See Muscular Kheumatism.) 
LUPUS. 

Is a chronic tubercular skin disease. In lupus, a tissue is 
formed like granulation tissue. Tubercles form, which may 
ulcerate, and are of a dull red color. When they heal, they 
leave a whitish scar (DaCosta). 

Causes. — The disorder occurs in syphilis, or in scrofulous 
persons. It appears often in childhood, and is attended with 
some pain and itching, and pursues a very slow course. The 
nose and cheeks are the favorite sites. In strumous subjects, 
lupus has a warty appearance. Some hold that lupus is the 
offspring of syphilis in the parents (DaCosta). 

Treatment, — Anti- strumous remedies should be given. Our 
sheet-anchor in most cases is cod-liver oil given for a long time. 
Next to cod-liver oil must be placed phosphorus. Arsenic may 
be given, also the syrup of the iodide of iron. Nitrate of silver 
should be applied locally (Anderson). 

PRESCRIPTIONS FOR LUPUS. 

R Zinci chloridi 

Antimonii chloridi aa gr. xx. 

Pulv. iridis florentinse rad gr. x. 

Acidi hydrochlorici puri XHx. — M. 

Sig. : Use as a caustic, spread on linen strips and leave on 24 
hours. — Kaposi. 

R Acidi pyrogallici 5j- 

Cerati simplicis gix. — M. 

Sig.: Apply locally. — Kaposi. 

R Acidi lactici puri Sj. 

Sig.: Apply to ulcer on absorbent cotton. — Wichmann. 

R Iodini 

Potassii iodidi aa gr. xv. 

Glycerinse HI. xxx. — M. 

Sig. : Apply locally. — Kaposi. 



LIPOMA LACTATION. 319 

LIPOMA. 

Is a tumor formed of a fat tissue. The fat tissue occurs in 
lobules and is similar to normal fat. Fatty tumors may undergo 
partial calcification. They are usually sharply circumscribed, 
but may infiltrate surrounding tissue. They are frequently pe- 
dunculated, and sometimes grow to enormous size, and may ulcer- 
ate. They are usually single but may be multiple. They are 
the most common of tumors. They are benign, or innocent 
tumors, not forming metastases. 

Occurrence. — They occur at all periods of life from infancy 
to old age, and are even congenital. They are more common in 
the female. As a rule, these tumors are encapsuled. They are 
soft, movable and free from pain. 

Situation. — Their most usual situation is the back of the 
neck and shoulders. 

Cause. — Unknown . 

Diagnosis. — Not difficult. The tumor will feel more or less 
firm and made up of lobes. The skin is usually loose over the 
tumor. 

Treatment. — When no necessity exists for their removal, 
tumors should be let alone. When large, unsightly and grow- 
ing, they should be removed by excision (Bryant and Prudden). 

LOCK=JAW. (See Trismus.) 
LACTATION. (Excessive.) 

Treatment. — When it is desirable to arrest the secretion of 
milk the gland may be enveloped by a belladonna plaster. A 
more elegant method is to envelop the breast in lint wet with 
a solution of atropine, four grains to the ounce of rose water. In- 
flamed breasts may be treated in the same way. Quinia has 
been recommended in excessive secretion of milk. An ointment 
made by boiling half an ounce of tobacco in eight ounces of lard 
kept constantly applied to the breasts, is also said to arrest the 
secretion of milk (Bartholow and Ringer). 



320 A COMPENDIUM OF PRACTICAL MEDICINE. 

LEAD COLIC. (See Colic). 

LENTIGO. (See Freckles). 

LEUCODERMA, 

Called also vitiligo, is an affection characterized by an ab- 
sence of pigment at certain parts surrounded by portions of skin 
in which it has accumulated to an excessive degree, so that brown 
patches are seen enclosing white ones. The white spots are at 
first circular in form, but uniting with each other become irreg- 
lar in shape. It may involve almost the whole body, but is 
usually confined to the hands, face and neck. It is most com- 
monly met with in persons of color. It is a rare affection (An- 
derson). 

Causes. — Some hold that it is a congenital affection. Its 
cause is very obscure, but there can be little doubt that it is 
a neurotic affection, and probably dependent upon perverted 
innervation of the sympathetic nerve. The exciting cause is 
sometimes apparently a lesion of some kind; as a burn, surgical 
operation, etc., (Anderson). 

Diagnosis. — Leucoderma is met with in all parts of the world. 
The general health of the patient is unaffected. The white 
patches are round and of a dead-white tint. There is no altera- 
tion in the structure of the skin. Sensation is normal (Anderson). 

Treatment. — Nerve tonics, such as phosphorus, strychnia and 
above all arsenic should be tried (Anderson). 

MALARIAL FEVERS. 

Are characterized by their prevalence in certain regions of 
the world known to produce the poison malaria, by their period- 
icity, and by the regular succession of the cold, hot and sweating 
stages. There are many varieties of malarial fever and they have 
received various names, such as fever and ague, chills, bilious 
fever, bilious remittent, remittent, intermittent, pernicious inter- 
mittent, congestive, "mountain fever of Colorado," continued 
malarial, typho- malarial, Chickahominy fever, "the shakes, ,r 



MALARIAL FEVERS. 321 

swamp fever, "Panama fever," "carnp fever 1 ' and periodical 
fever (Bartholow). 

Causes. — All varieties of malarial fevers have a common 
origin in a poison which has received the name of miasm, or 
malaria, and which is subject to certain variations in quantity. 
By some this miasm, or malarial poison, is regarded as gaseous 
in its nature, by others it is thought to be a living vegetable or- 
ganism, and. again others think it a specific poison, having no 
tangible, chemical or microscopical constituents. Certain proto- 
plasmic bodies have been found in the red corpuscles of malarial 
patients, which were called " plasmodium sanguinis malarise," 
but it is not known whether they are normal or are the cause or 
result of the malarial infection. But while we do not know the 
true nature of malaria, yet we do know something of the circum- 
stances which are necessary for its production. First, a certain 
amount of vegetable matter on or in the soil is absolutely neces- 
sary. Second, a certain amount of moisture on or in the soil is 
indispensable. Third, a certain degree of temperature is neces- 
sary. It cannot be developed below an average temperature of 
58° F. for the twenty- four hours. 

Infected Regions.— Marshes are especially favorable to the 
development of this poison, and may generate it for an indefinite 
period. The Pontine marshes, between Rome and Naples, have 
been malarial for more than two thousand years. But not all 
marshes produce malaria. The "Dismal swamp," for example, 
is free from marsh -miasm, although apparently well adapted to 
produce it. Its exemption is supposed to be due to the growth 
of the cypress -tree. If the marsh contains an abundance of 
water, malarial fevers are rare. If the marsh be covered with a 
thin sheet of water, or has dried up, malarial poison will 
abound. As a rule, salt water marshes are especially free from 
malaria, but when salt and fresh water are mixed in the marsh, 
the best conditions for malaria exist. Damp "bottom lauds 11 are 
as fruitful as swamps in the generation of this poison. Another 
condition which favors the development of malaria is the up- 
heaval of new alluvial soils in cultivating, or in excavating for 
railroads. Regions otherwise non-malarial may have malarial 
poison brought to them by the waters of rivers which have their 



322 A COMPENDIUM OF PRACTICAL MEDICINE. 

source in or flow through malarial districts, as along the banks 
of our Western rivers; or it may be brought to them by the 
wind. 

Circumstances which are inimical to the production of 
malaria are : 

I. High Latitude. — In this country malarial poison is not 
-generated in higher latitude than that of Quebec. The limit of 
its development is 63° north and 57° south latitude. The nearer 
the approach to the Equator, the more severe the type. 

77. High Elevation. — As a rule, it is not generated above 
an elevation of 1000 feet above the sea, but there are exceptions 
to this afforded by the so-called ''mountain fever" of Colorado, 
of the Pyrenees, and of the mountains of South America. 

777. Drainage and Cultivation. — In the majority of 
marshes, malaria can be prevented or arrested by free drainage. 
Yet there are marshes upon which millions have been expended 
in drainage and which still remain pestiferous, as for example 
the Jersey Flats and Pontine marshes. 

IV. Cold. — This is a powerful agent in arresting malarial 
generation. If the temperature should fall below the freezing 
point, only for one night, nothing more need be feared in that 
region from malaria, until the average temperature shall have 
again reached 60° F. This law holds in all malarial districts. 
Malaria is most active from June till November. Malaria is 
soluble in water, and Bartholow found the surface water of Kan- 
sas to produce malarial fevers and cholera. 

Some trees and plants possess the property of absorbing the 
malaria. The eucalyptus -tree has changed the nature of the 
malaria-breeding portion of the Algiers. The common sun- 
flower, planted in moist low-lands, will render the air salubrious. 
All ages are susceptible to malarial poisoning; and all races are 
equally so, except the black. Malarial poison may gain entrance 
into the human body through the respired air, or through food 
or drink (Bartholow and Loomis). 

Pathological Anatomy. — The changes caused by malarial 
poisoning are essentially the same, except degree, in all forms in 
which the disease manifests itself, and two organs (the liver and 
sjneen) are chiefly concerned. In acute cases, the spleen is 



INTERMITTENT FEVER. 323 

much enlarged. In some chronic cases the spleen undergoes 
enormous enlargement, and is known as u ague-cake." The liver 
becomes hyperaemic and swollen. The brain is also hyperseniic 
(Bartholow). 

Symptoms. — Prodromal stage. 

The incubation period is about fourteen days. During this 
time there are symptoms indicating that the infection is working. 
These are called prodromes. The patient has a feeling of lassi- 
tude and weariness, backache and general muscular soreness; he 
yawns and stretches, has headache, coated tongue and deranged 
stomach; in the evening his skin is warm and dry, but he has pro- 
fuse sweat in the morning. There may be yellow sclerotic, and 
a general yellowish hue of the skin, loss of appetite and consti- 
pation. The urine is loaded with bile pigment (Bartholow). 

INTERMITTENT FEVER, 

Called also, a fever and ague," " chill fever," "the shakes," 
" swamp fever," "Panama fever," is characterized by the occur- 
ence of febrile paroxysms in regular succession, and by the ab- 
sence of febrile movement between the paroxysms. The inter- 
mission is the distinctive feature of this form of fever, as its 
name implies. Like typhoid fever, intermittent fever is met 
with in all parts of the world, except in the extreme north or 
south. 

Morbid Anatomy. — The essential anatomical lesion in all 
forms of malarial fever is the presence of dark pigment in the 
blood and in certain organs. The only constant pathological le- 
sion of intermittent fever is congestion of the internal organs. 
The spleen and liver are always more or less enlarged, but the 
enlargement is due to simple hyperemia; no structural changes 
occur in these organs until the intermittent paroxysms have been 
often repeated, and the malarial poisoning has been of long dur- 
ation. There is also more or less hyperemia of the kidneys and 
mucous membrane of the intestine (Flint and Loomis). 

Cause. — Malarial poisoning introduced either through the 
lungs or intestinal tract (Loomis). 



324 A COMPENDIUM OF PRACTICAL MEDICINE. 

Symptoms. — Intermittent fever occurs in paroxysms. There 
are three simple types of this fever. The first and most common 
is the quotidian type, in which the paroxysm occurs every day, 
and there is an interval of 24 hours between the paroxysms. 
The second is the tertian type, in which the paroxysm occurs 
every third day, with an interval of 48 hours between the 
paroxysms. The third is the quartan type, in which the par- 
oxysm occurs every fourth day, with an interval of 72 hours 
between the paroxysms. There are other types, but they are 
only modified forms of those already mentioned, such as double 
quotidian, in which two paroxysms occur daily. Usually one 
paroxysm is severe, the other mild; the severe one generally 
occurs in the morning, the milder in the afternoon or evening. 
There is also the double tertian, in which a paroxysm occurs 
daily, but it differs from quotidian as the paroxysms that resem- 
ble each other occur at intervals of 48 hours. There is also the 
double quartan. In this type a paroxysm occurs on two suc- 
cessive days, and on the third day there is no paroxysm. Cases 
have been observed in which the paroxysm occurred on the fifth, 
sixth, seventh and eighth day, giving us a quintan, a sextan, a 
heptan, and an octan type of intermittent fever. The types 
most frequently met with are the quotidian, tertian and quartan. 
In the quotidian type the paroxysm occurs in the morning, in 
the tertian it occurs about noon, while in the quartan it occurs 
in the afternoon or evening. 

Duration of Paroxysm. — In the quotidian it lasts from 
eight to ten hours, in tertian it lasts from six to eight hours, in 
quartan from four to six hours. 

Description of a Paroxysm. — Paroxysms may occur at any 
hour of the day, but rarely at night. A paroxysm consists of 
three stages — the cold, the hot, and the sweating stage. 

Gold Stage. — Pain in the head, a sense of languor, and some 
nausea usually precede this stage. When the cold stage comes 
on, there is a sensation of coldness along the back, which soon 
extends to the extremities, and gradually creeps over the whole 
body. The skin becomes shrivelled, the finger ends and lips 
become blue, the face is pale, the eyes are sunken, chills rapidly 
follow each other, the teeth begin to rattle together and the bed 



INTERMITTENT FEVER. 325 

shakes. Tlie skin assumes the appearance of goose-skin. The 
temperature rises to 104° or 105° F., although the surface of the 
body feels cold. The pulse is small, rapid, and the tension high. 
There is precordial oppression and the voice is weak and husky. 
The respirations are rapid, short and sighing. The urine is in- 
creased in quantity and paler than normal, and there is a frequent 
desire to empty the bladder. There is extreme thirst and often 
nausea and vomiting. There is congestion of internal organs. 
The duration of this stage varies from a half hoar to two or 
three hours. Children do not have a regular chill; they merely 
grow cold, blue and livid. 

Hot Stage. — The skin becomes red, hot and swollen, and the 
blood recedes from the internal organs to the surface. There is 
intense pyrexia. The face is flushed and eyes red and fiery. 
The pulse grows full, rapid and strong. The headache con- 
tinues, but the pain in the limbs and precordial oppression dis- 
appear. The temperature marks 106° or 107° F. Thirst is 
intense. Sometimes herpetic vesicles appear about the mouth. 
The tongue becomes dry, the carotids pulsate, the head feels 
full; there are noises in the ears; there are nausea and vomiting, 
and there may be excitement and delirium. The urine in this 
stage becomes scanty and high colored. The duration of this 
stage is between three and eight hours and it is followed by the 
sweating stage. 

Sweating Stage. — The sweat appears first on the face and 
then on the trunk and extremities. The fever gradually abates 
and at length disappears. The heat of the surface, cephalalgia, 
thirst, restlessness, etc., cease. The patient obtains refreshing 
sleep. With this stage the paroxysm ends. The average dura- 
tion of the sweating stage is three or four hours. As a rule, the 
successive paroxysms recur precisely or nearly at the same hour. 
When the paroxysm comes on a little earlier each day, it is called 
anticipating, and indicates that the fever is not being controlled; 
when it comes on later each day, it then indicates that the fever 
is being controlled, and is called a postponing intermittent 
(Bartholow, Flint and Loomis). 

Intermission. — The intermission, called also the apyrexial 
period, is the space of time between two successive paroxysms. 



326 A COMPENDIUM OF PRACTICAL MEDICINE. 

During the intermission at first the patient may feel perfectly 
well, but if the disease continue, there will be a loss of vitality, 
he becomes pale and feeble with a yellowish, or sallow tint to the 
skin. There will be enlargement of the spleen and liver, and 
pigmentation of the tissues. These characters denote what is 
called the malarial cachexia (Loomis and Flint). 

Duration. — Of the disease is indefinite. It may continue 
for weeks or for months. The liability to relapse remains for 
many years. 

Dumb Ague, or Latent Intermittent Fever. — When the chill 
and sweat are absent, but a sense of heat, malaise, headache and 
lassitude come on at pretty regular periods in a malarial district, 
the thermometer showing a fever of 102° to 104° F. the patient is 
said to have ''dumb-ague" (Loomis). 

Differential Diagnosis. — Intermittent fever may be mistaken 
for remittent fever, pyaemia, and pulmonary phthisis. In remit- 
tent fever there is never a complete intermission, whereas in in- 
termittent there is always a period in which there is no fever. 
In remittent, there is usually but one chill, while in intermittent 
a chill precedes each paroxysm of fever. 

Pyaemia is very irregular in its course, no defined intervals 
occuring — intermittent is regular. Pyaemia is due to wounds, 
suppuration of veins, etc., intermittent to malaria. The former is 
a fatal disease over which quinia has no influence, the latter is 
promptly cured by quinine. Febrile paroxysms resembling 
those of intermittent fever are sometimes, observed in connection 
with pulmonary phthisis. They may present the three stages 
well marked, and recur at regular intervals. But they oftener 
occur in the afternoon than in the forenoon, whereas the reverse 
obtains in intermittent fever (Flint and Loomis). 

Treatment. — The treatment of the paroxysm is simply to 
render the patient comfortable. The patient should be kept in 
bed during the paroxysm. During the cold stage, cover him with 
blankets, surround him with bottles of hot water and let him 
drink freely of hot water. During the hot stage, the external 
heat should be gradually removed and cold drinks given. If 
nausea and vomiting are present give opium hypodermically. 
During the sweating stage let him alone. The treatment for the 



INTERMITTENT FEVER. 327 

intermission is to prevent the occurrence of another paroxysm. 
A patient should never be allowed to have a second intermittent 
paroxysm. The sulphate of quinia is our sheet anchor in this 
disease, and it is all powerful if skillfully used. At least thirty 
grains of quinine should be administered between the termina- 
tion of one paroxysm and the hour when another is to be ex- 
pected. The first dose of ten grains should be given toward the 
close of the sweating stage, and twenty grains about two hours 
before the time of the expected paroxysm. A moderate degree 
of cinchonism should be maintained for a number of days. 
About two hours before the time of day at which the first par- 
oxysm occurred from ten to fifteen grains of quinine should be 
daily administered. A full close of opium with the quinine will 
sometimes prevent a recurrence of the paroxysm. In some 
chronic forms of malaria, arsenic is of great service. Salicin, 
strychnia, piperine, eucalyptus, and hydrastia sometimes act 
when quinine fails. Flint has known a sinapism applied over 
the whole length of the spine at the beginning of the cold stage 
to arrest the paroxysm and effect a cure. A full opiate at the be- 
ginning of the cold stage often appears to shorten and modify the 
severity of the paroxysm. For the treatment of the enlarged 
spleen there is, besides the exhibition of quinine, no remedy more 
efficacious than the ointment of the red iodide of mercury, which 
is rubbed in daily over the splenic region in the sunshine, until 
soreness of the skin compels a suspension (Bartholow, Loomis 
and Flint). 

Prophylaxis. — Those living in, or going to malarial regions, 
susceptible to the action of the poison, must avoid all excesses of 
every kind, exposure to fatigue, to heat, to night air, and should 
take five or ten grains of quinine daily in the morning, in some 
black coffee, to procure immunity against malarial infection 
(Bartholow). 

PERNICIOUS INTERMITTENT FEVER. 

Called, also, malignant congestive or tropical typhoid is a 
severe form of the remittent or intermittent fever. It occurs in 
those places where the malaria is most concentrated, and the 
malarial fevers most severe. 



328 A COMPENDIUM OF PRACTICAL MEDICINE. 

Varieties. — There are several varieties, namely : the coma- 
tose, the delirious, the algid, the icteric and the gastro- enteric. 

Symptoms. — In the comatose variety during the hot stage 
the patient passes into a state of stupor and unconsciousness, 
lies upon his back, with a flushed face, congested conjunctiva, 
dilated pupils, slow, deep and stertorous respiration. He some- 
times passes into a condition of apparent death which may last 
for hours. If the patient survive the first and second paroxysms, 
he usually dies during the third. 

In the delirious variety, the patient after passing into the 
hot stage, becomes wildly delirious and requires restraint. This 
delirium may continue for hours. These attacks of delirium may 
be repeated three or four times before the patient dies. 

In the algid variety, after the patient enters the hot stage, 
the surface of the body begins to grow cold, has a marble -like 
feel, and the temperature in the axilla may fall to 88° F. or 84° 
F., while the rectal may range from 104° F. to 107° F. The 
pulse becomes slower and slower, falters, and disappears at the 
wrist. The patient has a death -like appearance. 

In the icteric variety, the patient has a violent long- con- 
tinued chill, during which jaundice shows itself. The jaundice 
gradually deepens and extends over the whole body. There is 
nausea and vomiting of bile. The temperature reaches 106° F. 
or 107° F. 

In the gastro enteric variety, the patient after passing into 
the hot stage, is seized with almost incessant vomiting and purg- 
ing. The discharges are stained with blood. There is a sense 
of burning in the stomach, cramps in the calves of the legs, cold- 
ness and blueness of the surface and sunken eyes (Loomis). 

Prognosis. — Unfavorable. 

Treatment. — Quinine and opium are the only reliable agents 
for this disease. From five to seven grains of quinine should be 
given hypodermically every hour until the paroxysm has passed 
away, then three grain doses every four hours. One -fourth of a 
grain of morphia should also be given and repeated if necessary. 
Warburg's tincture may be used with good results. A half 
ounce may be given at the outset of the paroxysm and this dose 
repeated if necessary (Loomis). 



REMITTENT FEVER. 329 

REMITTENT FEVER. 

Called also bilious fever, and bilious remittent fever, is a 
form of malarial fever characterized by the occurrence of re- 
missions instead of intermissions. 

Cause. — Malarial poisoning. 

Symptoms. — There are oppression in the epigastrium, lassi- 
tude, nausea, loss of appetite, and pain in the limbs and head. It 
does not come on gradually, like typhoid fever, but abruptly, 
usually with a chill. The chill is neither so complete, nor so 
long continued as in intermittent fever or pneumonia. There is 
no shaking; of the bodv or chattering of the teeth. Following 
the chill the temperature may reach 105° F. or 106° F. The face 
becomes flushed, the eyes congested, and there is vomiting of bile. 
The febrile symptoms increase in severity for ten or twelve hours, 
when a slight moisture appears upon the surface, and the tem- 
perature falls one or two degrees, but there is not a complete in- 
terruption; the fever is continuous. At the same hour the fol- 
lowing day all the active febrile symptoms return, and are more 
severe. This rise and fall of temperature constitutes the exacer- 
bation and remission. The febrile career ends during the second 
or third week. It eventuates in intermittent fever in a certain 
proportion of cases (Loomis). 

Treatment. — Quinine is all powerful in this disease. Loomis 
gives ten or twenty grains of quinine at a dose and repeats it 
every two hours until cinchonism is produced. He also gives 
full doses of bromide of potassium to promote sleep. Bartho- 
low gives thirty grains of quinine the first morning, twenty the 
second, fifteen the third, and ten the fourth, single doses, and all 
taken at once. 

CONTINUED MALARIAL FEVER. 

Called also typho-malarial, camp, and Chickahominy fever 
is an association of typhoid and remittent fevers. Many doubt 
the existence of such a form of fever, and regard the so-called 
typhoid element as nothing more than a typhoid condition, liable 
to be developed in connection with remittent fever, as well as 
with many other diseases (Loomis). 

Causes. — Are malarial poison, and some other poison. It is 
met with only in malarial districts. In large cities in which 



330 A COMPENDIUM OF PRACTICAL MEDICINE. 

malarial diseases are prevalent, anti- hygienic conditions, such as 
over- crowding and bad sewerage, seem to furnish the element so 
essential to its development (Loomis). 

Symptoms. — There are usually a distinct chill, pains in 
the limbs and back, headache, loss of appetite and a feeling of 
great exhaustion. The countenance has a peculiar waxy, yel- 
lowish tinge. There may be nausea and vomiting, abdominal 
tenderness in the right iliac region and diarrhoea. The tongue 
has first a white, then a red, and then a brown coating. Sordes 
may collect upon the teeth and lips. The average duration of 
the disease is three or four weeks (Loomis). 

Treatment. — When the malarial element predominates, 
quinine and Warburg's tincture are the best remedies. When 
the typhoid element predominates, give the regular typhoid 
remedies. 

CHRONIC MALARIAL INFECTION. 

Or malarial cachexia, may be a sequel of any form of acute 
malarial disease. It may develop in those who have never suf- 
fered from any form of malarial fever, but who have resided for 
some time in a malarial district. The patient becomes anaemic 
with enlarged spleen and liver (Loomis). 

Cause. — Malarial poisoning. 

Symptoms. — Some complain of vertigo, ringing in the ears, 
loss of memory, disturbances of sight, loss of appetite, nausea 
dyspetic symptoms, and pain and oppression in the epigastrium. 
Diarrhoea is often present. The sleep is disturbed. There may 
be pains in the back and loins. Some become easily fatigued on 
exertion, have shortness of breath and palpitation of the heart. 
There may be tingling and numbness of the limbs. Hemiplegia 
sometimes occurs. There may be catarrhal inflammation of the 
stomach, intestine and bronchial tubes. Neuralgia is quite com- 
mon in this affection (Loomis). 

Treatment. — The patient should be removed from a malari- 
ous district to a high, warm, mountainous region. He should 
wear flannel next to the skin and avoid exposure to wet and cold, 
and the damp air of evenings and nights. Quinine must be given 
in full doses. If there is angemia iron must be given. The iodide 



MALARIAL FEVERS. 331 

of iron combined with cod liver oil will he found of great service. 
One -half an ounce of Warburg's tincture taken daily for ten 
da vs. two hours before breakfast, is often efficacious when qui- 
nine fails. Aloes or rhubarb should be given, if the bowels are 
constipated. Arsenic may be tried. A nutritious diet and the 
daily use of brandy in small quantities are often of great service 
(Loomis). 

PRESCRIPTIONS FOR MALARIAL FEVERS. 

R Quinia? sulphatis ^iss. 

Acidi sulphurici dil, 3ss. 

Spts. setheris uitrosi 5ss. 

Syrupi tolutan. 

Aqua? aa.-.q. s....ad,...§iij. — M. 

Sig. : A teaspoonful three or four times a day. — DaCosta. 

R Chinoidini gr. xL. 

Resina? podophylli gr. iv. 

Ferri sulph exsic gr. xx. — M. 

Ft. massa et in pil. no. xx. div. 
Sig. : One three times daily. — Bartholow. 

R Tinctura? iodi 3vj. 

Potassii iodidi 5ij- 

Aqua? cinnamonii ad 5iij. — M. 

Sig.: A teaspoonful three times daily. — Charity Hospital. 

R Acidi carbolici gj. 

Tincturse iodi comp ^iij . — M. 

Sig.: Four drops every four hours well diluted. — Bartholow. 

R Quinina? sulphatis gr. xyj. 

Ext. glycyrrhizse 5j- 

Syr. rubri idaei oij- — M. 

Sig.: A teaspoonful three to five times daily for a child three 
years old. — J. Lewis Smith. 

R Pulveris opii gr. xij . 

Pulveris capsici gr. xxxvi. 

Quinina? sulphatis 5j- — M. 

In pulveres no. xii. div. 
Sig.: One powder three times daily. — Alonzo Clark. 



332 A COMPENDIUM OF PRACTICAL MEDICINE. 

MASTITIS. (See Inflammation of Breast). 
PRESCRIPTIONS FOR MASTITIS. 

R Ammonii carbonatis §j. 

Aquse Oj.— M. 

Sig.; Apply locally. — Starr. 

R Cerati resinse comp Sj. 

Olei olivse gj-ij. — M. 

Ft. ungt. 
Sig.. Apply, spread generously on soft linen. (When suppura- 
tion is threatened). — Witherstine. 

R Lini farini 

Aquae bullientis aa q.s... 

Ft. cataplasma. 
Sig.: Apply as hot as can be borne. — Witherstine. 

R Linimenti camphorse Sviij. — M. 

Sig. : Apply locally, rubbing gently from the circumference 
toward the nipple. (In incipient mastitis.) — Parry. 

R Atropinse sulphatis gr. viij. 

Aquas rosse 5ij. — M. 

Ft. lotio. 
Sig.: Apply locally, but discontinue in case of dilatation of 
pupils, or dryness of throat. — Starr. 

MANIA. (Acute and Chronic.) 

Maniacal conditions are so familiar and so readily recognized 
that they need not be described here. There are mainly two 
disorders with which acute mania is liable to be confounded, 
namely — acute meningitis and delirium tremens. 

In acute meningitis, there are severe headache, drowsiness, 
tingling and numbness in the extremities, tense pulse, decided 
fever, etc. In acute mania, the patient has little if any fever, no 
spasms; his pupils are not contracted; his stomach is not irrita- 
ble, and has no headache. 

In delirium tremens, he is talkative and restless, has a moist 
skin, compressible pulse, and creamy tongue. In acute mania 
these conditions do not prevail (DaCosta). 



MANIA MARASMUS MEASLES. 333 

PRESCRIPTIONS FOR MANIA. 

Jfc Potassii bromidi gj. 

Tinct. cannabis indicse gj . 

Syrupi simplicis ,^ij . 

Aquae q. s., ad §iv. — M. 

Sig. : A tablespoonful thrice daily. — Clouston. 

|fc Hyoscyamise sulphatis „ gr. j. 

Aquas destillatse gxij . — M. 

Sig.: Five to twelve minims hypodermically. 

MARASMUS. 

Is a general wasting, emaciation, or atrophy. There are 
many constitutional diseases which produce a condition known as 
marasmus. The following prescriptions are useful in this con- 
dition : 

jfc Tinct. cinchonse comp 

Tinct. gentinse comp aa §j. — M. 

Sig. : Fifteen drops to a teaspoonful in sweetened water, thrice 
daily. J. Lewis Smith. 

j& Syr. ferri iodidi gj. 

Sig. : Three to five drops in water thrice daily after eating. 

— Eustace Smith. 

jfc Olei morrhuae Sij. 

Aquae calcis giv. 

Syr. calcis lactophosphites...ad...§iv. — M. 
Sig.: A teaspoonful two or three times daily. — Bosley. 

MEASLES. 

Called also rubeola and morbilli, is an eruptive fever, with 
catarrhal symptoms referable to the broncho-pulmonary mucous 
membrane, self-limited and terminating in about two weeks 
(Bartholow). Measles is a disease from which few persons es- 
cape. It is essentially a disease of childhood, but it may occur 
at any age. A second attack is of rare occurrence. It is char- 
acterized by an eruption of red spots. It is contagious (Loomis). 

Causes. — Measles appears in .alljparts of the globe. The dis- 
ease may be communicated not only by contact with the sick, 
but the morbific principle adheres to articles of clothing by which 



334 A COMPENDIUM OF PRACTICAL MEDICINE. 

it may be conveyed long distances, or in other words it is a port- 
able disease. Measles prevails as an epidemic, and in the spor- 
adic form. All are not alike susceptible. Infants at the breast 
are not liable. The disease prevails mostly in the fall, winter and 
spring. The duration of the period of incubation varies from 
one to thirty days; the average being ten days (Bartholow and 
Loomis). 

Symptoms. — The course of this disease is definite and is di- 
vided into the stages of invasion, eruption and desquamation. 

Stage of Invasion. — At the end of the period of incubation, 
the patient begins to suffer from cough, fever, anorexia, thirst, 
chills, a feeling of weariness, muscular soreness, headache and 
backache. There is an acrid muco- serous discharge from the 
nostrils. The eyes are irritable, reddened and watery, and have 
a brilliant appearance. The buccal and faucial surfaces are in- 
jected. Sore throat is complained of, and the voice is a little 
husky. The bronchitis, laryngitis and coryza which accompany 
this disease are due to the efflorescence which takes place on the 
mucous membrane of the air-passages prior to its appearance on 
the skin. There may be nausea and vomiting. The face is 
flushed and somewhat swollen. Epistaxis is frequent. The 
average duration of the stage of invasion is three or four days. 
It may, however, be a single day or seven days; then the erup- 
tion appears (Flint, Smith and Loomis). 

Stage of Eruption. — The eruption is first seen upon the 
forehead, chin and sides of the nose, then upon the neck, chest 
and over the body, afterwards upon the legs and arms, and lastly 
upon the back of the hand. The eruption on the face feels like 
small shot early in the disease. The eruption fully develops in 
36 to 48 hours, and then begins to fade. Convulsions may 
occur in this stage. The eruption has at first an appearance of 
minute red dots and specks which soon enlarge to the size of a 
pin -head or to three pin -heads; they disappear upon pressure 
and return when the pressure is removed. These spots are 
usually discrete and separated by tracts of normal skin. The 
eruption is sometimes attended with considerable itching. The 
efflorescence may be seen on the hard and soft palate one or two 
days before it appears on the face. In this stage the constitu- 



MEASLES. 335 

tional and local symptoms increase in severity. The face is 
swollen, the eyes still watery and sensitive to light; the tongne 
is covered with a moist thin fur, and its papillae are prominent, 
though less so than in scarlet fever. The cough continues, the 
appetite is lost, and thirst is intense. A severe form of the dis- 
ease is characterized by the occurrence of petechia and hemorr- 
hage in various situations. In these cases the eruption presents 
a livid appearance, and is called hemorrhagic rubeola, or rubeola 
nigri or black measles. Some writers describe measles without 
catarrh, and on the other hand with catarrh, but without the 
rash. On the fourth day of the eruption it begins to fade, and 
the stage of desquamation commences (Flint, Smith, Loomis and 
Bartholow). 

Stage of Desquamation. — The duration of this stage is be- 
tween four and eight days. It is characterized by a scanty fur- 
furaceous exfoliation of the epidermis. In this stage all the 
symptoms rapidly abate, but the cough continues several days 
(J. Lewis Smith). 

Complications. — The most important complications are 
bronchitis, capillary bronchitis, broncho -pneumonia, meningitis, 
ophthalmia, otorrhoea, entero- colitis, eclampsia, diphtheria, and 
acute tuberculosis. Nephritis is a rare complication (Smith). 

Prognosis. — Is always good in uncomplicated cases, but the 
various complications render the prognosis unfavorable (Smith). 

Treatment. — Uncomplicated cases require little medical 
treatment. The child should be kept in an airy room at a uni- 
form temperature of about 70° F. The diet should be mild and 
for the most part liquid. Stimulation by wine or brandy may 
be necessary. For the troublesome cough, flaxseed tea or infus- 
ion of slippery elm bark, with lemon juice added may be given. 
A small Dover's powder is good for the cough. The chest should 
be covered with cotton wadding, after rubbing on camphorated 
oil. If the patient complains of itching and burning of the sur- 
face, he may be frequently sponged with tepid water. If there 
is thirst, cold water may be freely taken in small quantities at a 
time. Inhalations of steam are most useful for the lung compli- 
cations. In capillary bronchitis and pneumonia the following 
prescription is most serviceable : 



336 A COMPENDIUM OF PRACTICAL MEDICINE. 

R Ammonii carbonat gr. xvj. gss. 

Aquae purse Sij . — M. 

Sig. : Give one teaspoonfal in three or four of milk every hour 
or two. The chloride of ammonium is also good in double the dose of 
carbonate (Smith). If the temperature is high during the initial 
stage, and the cough troublesome, the following is most effective : 

Jfc Tinct. aconit. rad gj. 

Ext. ipecac fid.. 3ij. 

Tinct. opii deodorat , . ^iij . — M. 

Sig. : Six drops every hour or two. — Bartholow. 

During the time of the eruption, if the temperature is high 
the skin should be rubbed every four hours with lard, suet, vase- 
line or cocoa- butter. A simple saline laxative ought to be 
given. Quinine may be used to reduce the fever (Bartholow 
Loomis and Smith). 

MELANCHOLIA. 

Is a form of insanity characterized by a condition of mental 
depression. Melancholiacs have gloomy visages. 

Causes. — Diseases of the brain, angemia, and physical pros- 
tration. 

Symptoms. — The patient is dreadfully depressed and his ex- 
pression is completely altered. He suffers from no appreciable 
disease. Usually he gazes toward the ground. The tendency of 
the melancholic is frequently to suicide. 

Treatment. — It is necessary to isolate melancholic patients 
from their friends and relatives. The use of opium in the form 
of the tincture, in gradually increasing doses, is productive of 
the best results. A prolonged warm bath (one -half to two hours) 
is a good hypnotic agent in melancholia. Frequent feeding is 
of the greatest importance (Starr). The bromide of potassium 
is most serviceable for the unendurable despondency (Ringer). 

PRESCRIPTIONS FOR MELANCHOLIA. 

Jfc Qninia3 valerianatis 

Ferri valerianatis , 

Zinci valerianatis— aa gr. xx. — M. 

Ft. rnassa et in pil. no. xx. div. 
Sig.: One pill three times daily. — Witherstine. 



MENINGITIS. 337 

Jfc Potassii bromidi >..-3ij. 

Tinct. calumba giij. 

Spts. ammonise aromat ^ij. 

Aquse cinnamoni §iij . 

Aquaa q. s., ad §viij. — M. 

Sig.: A wineglassful two or three times daily. — Lawrence. 

{£r Tinct. ferri chloridi 

Syr. simplicis — aa gj . — M. 

Sig. : Twenty drops well diluted thrice daily. — Bartholow. 

MENINGITIS. 

Inflammation of tlie pia mater is usually called meningitis. 
The term pachymeningitis is applied to inflammation of the dura 
mater (Loomis). Sometimes inflammation of the pia mater is 
denominated leptomeningitis. It may be acute or chronic. 
Acute cerebral meningitis is also called simple meningitis of the 
convexity, cerebral fever, and arachnitis. 

Causes. — Acute alcoholismus, prolonged and intense mental 
anxiety and grief are among its predisposing causes. Injuries of 
the cranial bones, as fractures, severe blows, or punctured wounds 
are the most frequent exciting causes. Diabetes, cerebral tumors, 
disease of the cranial bones, suppuration of the middle ear, and 
eyeball, and large carbuncles about the cranium have caused it. 
Meningitis may occur as a complication, in measles, small -pox. 
scarlet fever, ulcerative endocarditis, Bright 's disease, acute 
pneumonia, typhus, typhoid fever, diphtheria, pyaemia, and rheu- 
matism. Long continued exposure to intense heat of the sun 
may cause it. It is more common in males than in females. It 
is most frequent in early adult life and in young children (Flint 
and Loomis). 

Symptoms. — May be divided into three stages of headache, 
delirium, and coma. It may be ushered in by a distinct chill or 
chilly sensations. The first prominent symptom, as a rule, is a 
violent headache. With the headache there is vertigo, intense 
photophobia, loud ringings in the ears, nausea, and projectile 
vomiting. The face is flushed, and has an anxious expression. 
The conjunctiva are injected, and the pupils are contracted. The 
bowels are constipated and the abdomen is retracted. The fever 



338 A COMPENDIUM OF PEACTICAL MEDICINE. 

is more or less intense, and the pnlse is accelerated, strong and 
full. The carotids and temperal arteries pulsate strongly, and 
the head is hot. The duration of this stage is one or two days. 

In the second or stage of delirium, there are great restless- 
ness and mental confusion. The delirium is sometimes wild, 
simulating acute mania. In adults, muscular twitchings of the 
face and extremities are present in this stage; the eyeballs roll 
about vaguely, the flexor-muscles are often powerfully contracted 
in one or both limbs, and there may be opisthotonos. The tem- 
perature rises to 104° F., the pulse becomes more frequent and ir- 
regular; the abdomen is retracted, the vomiting continues pro- 
jectile. Herpetic eruptions appear. This stage lasts from one 
to three days. 

The third stage is called the stage of coma. It comes on 
gradually. The delirium and headache subside. There is a ten- 
dency to stupor and deep sleep. The pulse becomes slow, irreg- 
ular and intermittent. The pupils are greatly dilated. There 
is rigidity of the muscles of the back of the neck. Strabismus 
and loss of vision may occur. The patient rolls his head and 
grinds his teeth and picks stupidly at the bedclothes. Gradually 
the coma becomes profound. Subsultus tendinum is marked. 
As the disease advances, the pulse may run up to 160 or 170 
or more; the Cheyne- Stokes respiration of ascending and descend- 
ing rhythm becomes established. The expirations are puffing. 
The body is bathed in cold sweat (Flint and Loomis). 

Differential Diagnosis. — Acute meningitis may be confounded 
with cerebral hyperemia, acute uraemia, variola and delirium tre- 
mens. From cerebral hyperemia, meningitis is differentiated by 
the higher temperature, longer duration, and the symptoms of 
depression succeeding to a stage of excitement. In uraemia the 
temperature is usually below rather than above the normal; the 
urine is scanty and contains albumen, and there is or has been 
dropsy. In small -pox, the face is flushed, the pulse full and 
bounding, there is intense pain in. the back and loins, the vomit- 
ing is retching in character, and at the end of the third day the 
characteristic eruption appears. In delirium tremens, the patient 
imagines persons and animals about him, and is wild in his ges- 
tures and utterances. The surface is bathed in a profuse, 



]ME^s T IXGITIS. 339 

clammy sweat in delirium tremens; it is hot and dry in meningitis. 
In delirium tremens the temperature, pulse rate, and pupils are 
normal, and there is no headache (Bartholow and Loomis). 

Prognosis. — Is very unfavorable. The duration varies from 
two days to four weeks; fatal cases rarely last more than eight 
days. Strabismus, hiccough and local paralysis are very unfavor- 
able symptoms. 

Treatment. — The head should be raised; the room dark and 
quiet. The ice-bag should be put to the head. Leeches may be 
applied to the nape of the neck and mastoid bone. The bowels 
should be moved freely. Blisters may be applied to the back of 
the neck. Bartholow recommends during the stage of excita- 
tion, tincture of aconite (two drops) every two hours. He also 
gives bromide of potassium (5ss.) andiluid extract of ergot (5ss.) 
every four hours. Iodide of potassium in five to ten grain doses 
four or five times daily may be given. 

PRESCRIPTIONS FOR ACUTE CEREBRAL MENINGITIS. 

R Acidi tannici 5j. 

In capsulas no. xx. div. 
Sig. : A capsule every three hours, with ice to head. — Lardier. 

R Sodii bromidi 5ij 

Chloral hydratis 5j • 

Syr. auranti cort Jj. 

Aquae q. s., ad oiij. — M. 

Sig : A dessertspoonful every hour or two until excitement 
abates. — Herrman. 

R Tincturae ferri chloridi oj . 

Sig.: Twenty to thirty minims every two hours. — Klapp. 

Chronic Cerebral Meningitis. — Is an interstitial inflamma- 
tion of the pia mater which causes thickening and opacity of the 
membrane (Loomis). 

Causes. — It is a disease of adult life, especially after fifty 
years of age. It may be a combination of chronic alcoholismus, 
syphilis, rheumatism, gout and chronic Briglit's disease ( Loomis). 

Symptoms. — Are obscure. The patient grows dull, stupid 
and apathetic. There is headache and a constant desire to sleep. 



340 A COMPENDIUM OF PRACTICAL MEDICINE. 

Vomiting occurs. There is muscular weakness, vertigo and tin- 
nitus aurium (Loomis). 

Treatment. — The patient must be kept quiet mentally, and 
the diet must be fluid and nutritious. The bichloride of mercury 
and iodide of potassium are considered the best remedies. The 
bowels and urine need careful attention (Loomis). 

Tubercular Meningitis. — Called also basilar meningitis, is 
an inflammation of the basal pia mater caused by gray miliary 
tubercles and occurring most frequently in children (Loomis). 

Causes.- — It is rare before the first and after the fifth year. 
It occurs most frequently in scrofulous children. An}^ debili- 
tating disease may excite it. The immediate cause is the same 
as in all forms of tuberculosis (Loomis). 

Symptoms. — There is loss of appetite; the breath is offen- 
sive; the tongue coated, constipation and diarrhoea alternate. 
The child becomes dull, languid, and desires quiet. The face 
has an anxious appearance. There may be convulsions. In the 
first, or irritative stage, the patient will moan and clasp the head 
with his hands. He awakes with a piercing hydrocephalic cry, 
grinds his teeth, rolls his eyeballs, and the facial muscles are 
contorted. The hands will be clenched. The abdomen is re- 
tracted and hard. Projectile vomiting occurs, and resists all 
treatment. The pupils are contracted, there is photophobia. In 
the second, or stage of depression, the muscles at the back of the 
neck become rigid; the head is rolled slowly from side to side; 
sometimes distinct opisthotonos occurs. The pulse becomes 
slow; convulsions, ptosis, strabismus, loss of sight, anaesthesia 
and local paralysis may occur. There is difficult swallowing. 
Oheyne- Stokes' respiration is common. There is anorexia, the 
tongue and mouth are covered with sordes; and the passages are 
unnatural and offensive. In the third, or stage of coma, the 
pulse runs up to 150 or 170 per minute, is feeble, small and 
irregular. The pupils are widely dilated. The breathing is 
sighing or snoring in character. Dysphagia is marked. The 
contents of the bladder and rectum are passed involuntarily; the 
body is covered with a clammy sweat. The abdomen becomes 
tympanitic and subsultus tendinum is marked (Loomis). 



MEXIXGITIS. 341 

Differential Diagnosis. — Tubercular meningitis may be mis- 
taken for acute meningitis, gastro- enteritis, acute Bright' s dis- 
ease and infantile remittent fever. 

Acute meningitis is sudden in its onset and rapid in its pro- 
gress, not so in tubercular. The ocular symptoms and the boat- 
shaped abdomen are more prominent in the tubercular than in 
other forms of meningitis. In gastro- enteritis, there are diar- 
rhcea, abdominal pain and tenderness. But headache, contracted 
pupils, photophobia, the slow irregular pulse, reflex movements 
during sleep, projectile vomiting and the hydrocephalic cry of 
tubercular meningitis are wanting. 

In B vigli f s disease, the oedema, with the presence of albu- 
men and casts in the urine, will establish the diagnosis. In 
infantile remittent the vomiting is retching in character, diarrhoea 
is prominent, and the discharges pea -soup in character, the 
abdomen is distended and tender; there is great thirst, rapid 
pulse and normal pupils (Loomis). 

Prognosis. — It is one of the most fatal diseases of childhood. 
The duration varies from five days to four weeks (Loomis). 

Treatment. — The prophylactic treatment is cod-liver oil, and 
the patient kept out of doors as much as possible, also good 
hygienic surroundings. The treatment is symptomatic after the 
disease is developed. The bowels must be kept open, and abso- 
lute quiet enjoined. Ice-bags may be put to the head. Opium 
and bromide of potassium are serviceable in the stage of excite- 
ment (Loomis). 

PACHYMENINGITIS. 

Is an inflammation of the dura mater. There are two 
forms, namely : Pachymeningitis, externa and interna. 

Causes. — Pachymeningitis externa is caused by injury and 
disease of the cranial bones, by suppuration of the internal or 
middle ear, or of the orbit. The causes of the internal form are 
chronic alcoholismus, pyaemia and Bright's disease. It is rare 
before forty, most frequently between sixty and eighty (Loomis). 

Symptoms. — Somnolence, headache, dizziness, photophobia, 
followed by delirium, and perhaps convulsions and coma, are the 



342 A COMPENDIUM OF PRACTICAL MEDICINE. 

cliief symptoms. The course of the disease varies from one day 
to a year or more (Flint). 

Treatment. — For the external form, rest, a mild diet, a free 
purge, and cold to the head are indicated. Trephining may 
sometimes save life. If there are symptoms of suppuration alco- 
holic stimulants, quinine, and opium should be given. The ex- 
ternal form must be treated symptomatically. The prognosis is 
unfavorable in both forms (Loomis). 

SPINAL MENINGITIS. 

Is an inflammation of the spinal pia mater and arachnoid. 
It may be acute or chronic. 

Causes. — Acute spinal meningitis may be caused by a fall, 
blow, dislocation, fracture or other injury to the vertebrae, or 
concussion; by any disease of the spine, such as caries, cancer, 
prolonged exposure to cold — especially damp cold- — or brief ex- 
posure to intense cold when the body is heated, as well as ex- 
posure to intense heat. Operations for spina bifida have been 
followed by rapid and fatal spinal meningitis. Syphilis, venereal 
excesses, alcoholismus, chorea, tetanus, and hydrophobia may 
cause it. 

The chronic form may follow the acute (Loomis). 

Symptoms. — More or less pain is felt in the spine radiating 
therefrom to the extremities. The pain is increased by move- 
ments of the body and is constant. The surface of the body be- 
comes hyperaesthetic, and the reflexes are increased. There may 
be a chill, nausea, vomiting, fever, and the muscles along the 
spine' become rigid. There is constipation, and the abdomen has 
the well known boat shaj^ed appearance. The duration of this 
disease is seven to ten days. The majority of cases are fatal 
(Flint). 

Treatment. — The indications for treatment are the same as in 
acute cerebral meningitis. The patient should be put to bed in 
a cool room and a brisk purge administered. Ice or counter irri- 
tation may be applied along the spine. Ergot and belladonna 
are said to produce contraction of the arterioles, and retain the 
inflammatory process. 



MENINGITIS MYELITIS. 343 

When the symptoms denote the presence of the products of 
inflammation, vesication of the spine and iodide of potassium in 
large doses are indicated. Warm baths are grateful to patients 
(Flint and Loomis). 

The different varieties of meningeal inflammation and the 
terms applied to each may be made clearer by the following 
definitions : 

1. By the term meningitis is usually understood inflamma- 
tion of the pia mater or of the pia mater and arachnoid. 

2. By the term leptomeningitis is meant inflammation of 
the pia mater, or of the pia mater and arachnoid of the non- tu- 
bercular variety. 

3 By the term simple cerebral meningitis is understood in- 
flammation of the pia mater either of the convexity or of the base 
of the non- tubercular variety. 

4. By the term tubercular meningitis is meant an inflam- 
mation of the basal pia mater caused by tubercle bacilli. 

5. By the term pachymeningitis is meant inflammation of 
the dura mater. 

The same terms are applied to spinal meningeal inflam- 
mation. 

MYELITIS. 

Is an inflammation of the substance of the spinal cord. It 
may be acute or chronic. 

Forms. — When the inflammation occurs chiefly in the central 
gray matter, it is called central myelitis; when the white matter 
and meninges are involved it is called cortical myelitis; when 
both white and gray matter of the greater portion of the cord 
are inflamed the process is called diffuse myelitis; when the in- 
flammation is confined to the anterior-horns of gray matter, it is 
called anterior polio -myelitis; when all the tissues of the cord 
over a circumscribed space are involved it is called transverse 
myelitis; when there are spots of inflammation along the cord at 
various points it is called disseminated myelitis. Acute myelitis 
in the majority of cases, appears under the form of softening of 
the cord. Chronic myelitis, on the other hand appears as indu- 
rated or sclerosis (Flint). 



344 A COMPENDIUM OF PRACTICAL MEDICINE. 

Acute Myelitis. — Causes. — Acute myelitis is a rare disease. 
It is more common in males than in females. It is a disease of 
children and young adults. In children it takes the form of 
acute anterior polio -myelitis or spinal paralysis. Injuries of the 
cord from contusions, blows, fractures of the vertebra, intense 
and prolonged muscular action, prolonged exposure to cold, as in 
sleeping on damp ground, sudden chilling of the surface when 
overheated and excesses in coitus are given as causes. It is said 
that suppression of the menses and checking hemorrhoidal fluxes 
may cause it. Acute infectious disease may give rise to myelitis. 
Continued jarring of the spine from travel on railways will 
produce it (Bartholow, Loomis and Flint). 

Symptoms. — Acute myelitis usually begins with fever, intense 
pain in the back, the sensation of a girdle around the trunk, ten- 
derness over certain of the vertebrae, pains and muscular soreness 
of the limbs, tingling, formication, a feeling of weight and drag- 
ging in the rectum and bladder, and priapism. Preceding paralysis, 
the muscles which are to be paralyzed are sometimes affected 
with tremor or spasm. The early occurrence of paralysis is a 
distinguishing feature. It occurs within a day or two, and some- 
times within a few hours after the symptoms have pointed to a 
spinal affection. The paralysis is mostly paraplegic, affecting 
both bladder and rectum, is motor and sensory, and may develop 
so rapidly that in 48 hours the patient will be unable to move 
his legs. Loss of reflex excitability is an effect of destruction of 
the gray matter in the lower part of the cord. Notable wasting 
of the paralyzed muscles is indicative of destruction of the gray 
matter. In myelitis, the parts exposed to pressure take on gan- 
grenous inflammation. Acute myelitis is a progressive disease, 
and may run a rapid course, destroying life in a few days or 
weeks. Complete recovery is rare (Bartholow, Loomis and 
Flint). 

Differential Diagnosis. — Acute myelitis may be confounded 
with acute spinal meningitis. In meningitis, there are acute pain 
on motion, rigidity, spasms and contractions of the muscles of 
the back, hyperesthesia, and incomplete paralysis; in myelitis, 
there is no pain on motion, the muscles are flaccid and relaxed, 



MYELITIS. 345 

there are anaesthesia and paraplegia, or hemiplegia (Loomis and 
Bartholow). 

Prognosis. — In acute myelitis death may occur in twelve to 
thirty hours, or be delayed two or three weeks (Loomis). 

Treatment. — Absolute rest must be enjoined. Frequent 
applications of hot water to the spine is very serviceable. The 
ice-bag to the spine is recommended. Bartholow recommends a 
mustard plaster the length of the srjine and four inches wide, to 
be applied twice daily. Dry cupping over the spine and leeches 
are indicated. Internally ergot and belladonna have been highly 
recommended. Authorities recommend a tablespoonful four 
times daily of the infusion of digitalis. Twenty to thirty grain 
doses of quinine may have a good effect at the very beginning 
of the congestive stage. Purgatives should be given. Bed-sores 
must be prevented. Cystitis may be avoided by the frequent 
use of the catheter and washing out of the bladder (Bartholow, 
Loomis and Flint). 

CHRONIC MYELITIS. 

Causes. — Are much the same as those of acute myelitis. 

Symptoms. — Pains in the limbs simulating rheumatism, mus- 
cular weakness, tingling, formication, numbness of the limbs, 
and a girdle sensation are the first symptoms. These are fol- 
lowed by paraplegia, muscular atrophy, cystitis and chronic bed- 
sores. Patients with chronic myelitis always complain of cold 
feet. 

Prognosis. — Always unfavorable. It may continue from two 
to ten years (Loomis). 

Treatment. — The treatment for the acute will be of service 
in the chronic form. 

Chronic Myelitis includes several distinct affections, among 
which are posterior spinal sclerosis (which has been considered 
under the name of locomotor ataxia), multiple cerebro- spinal 
sclerosis, sclerosis of the lateral columns, anterior polio-myelitis. 
and progressive muscular atrophy. 



346 A COMPENDIUM OF PKACTICAL MEDICINE. 

MULTIPLE CEREBRO=SPINAL SCLEROSIS. 

Is a malady characterized by the formation of isolated 
patches or nodules of sclerotic tissue in the brain, pons, medulla, 
cerebellum, and spinal cord (Bartholow). The nodules vary in 
number and range in size from minute objects to the size of a 
walnut (Loomis). 

Causes. — It is very rare after the age of forty -five and be- 
fore ten. Heredity is a predisposing cause. The exciting causes 
are damp and cold, sudden chilling of the body, traumatism, 
and severe and long- continued brain work or physical exercise. 
Moral emotions, chagrin, anxiety, and continued jarring of the 
body are thought to produce the disease (Bartholow and 
Loomis). 

Symptoms. — The disease may come on gradually or sud- 
denly. If it appears gradually, the patient complains of head- 
ache, vertigo, muscular weakness, mental disturbance, and queer 
feelings, as formications, itchings, burnings, etc., in the limbs. 
There may be nausea and vomiting. There is a loss of co-ordi- 
nating power, and the patient cannot control his hands in writing, 
or his feet and limbs in walking. There is a shaking tremor; 
this tremor is peculiar in not occurring until an attempt is made 
at voluntary motions, and at once ceasing when the parts are 
allowed to rest. Even the head participates in it. The voice is 
changed, and the patient talks in a low monotone or a whisper, 
dividing the words as in scanning a line of poetry. Amblyopia, 
diplopia, nystagmus, and inequality of the pupils are frequent 
symptoms. In the advanced stage, vesical symptoms, acute bed 
sores, loss of sexual power and control of the sphincter become 
marked symptoms. 

Differential Diagnosis. — Cerebro- spinal sclerosis may be mis- 
taken for paralysis agitans or locomotor ataxia. In paralysis 
agitans the fine tremor exists when the patient is at rest, and is 
not accompanied by shaking of the head; while in the shaking 
of the cerebro -spinal sclerosis the head is always involved, the 
symptom ceasing as soon as the patient is at rest. The former is 
rare before forty; the latter is rare after forty. Changes in the 
voice and speech and ocular symptoms are present in cerebro- 



SCLEEOSIS. 347 

spinal sclerosis, and absent in paralysis agitans. In locomotor 
ataxia the peculiar shaking tremor, impairment of voice and 
speech, and nystagmus that belong to disseminated sclerosis are 
absent. In the former there are the girdle sensation about the 
trunk, the lightning-like rjains and the peculiar double beat in 
walking, all of which are absent in the latter (Loomis and Bar- 
tholow). 

Prognosis. — The disease is progressive and always terminates 
in death. The duration varies from one year to twenty, but the 
average is five to ten years. The patient is apt to die from 
an intercurrent disease (Bartholow and Loomis). 

Treatment. — Various remedies have been proposed for this 
malady. Erb gave arsenic hypoclermically in one case with im- 
provement. Hammond thinks the chloride of barium does good. 
According to Bartholow the chloride of gold and sodium, with 
small doses of corrosive sublimate, is most useful. Cod-liver oil, 
nitrate of silver, phosphate of zinc and galvanism have all been 
used by authorities. 

LATERAL SPINAL SCLEROSIS. 

Called also by Charcot, spasmodic tabes clorsalis, and by 
Erb spastic spinal paralysis, is a disease having similar lesions to 
those of posterior spinal sclerosis, but a different seat. The 
site of the lesions is the lateral white columns, and the changes 
consist in gray degeneration. 

Causes. — It develops under the same conditions as posterior 
spinal sclerosis. It is more common in men than in women, and 
occurs between the ages of twenty and fifty. Traumatism and 
exposure to wet and cold are given as causes (Loomis). 

Symptoms. — There will appear first weakness and paresis of 
the lower extremities; then twitching of the muscles and muscu- 
lar rigidity follow. The tendon reflexes in this disease are much 
exaggerated. The sensibility is unaffected; there is no atrophy 
of the muscles; and the functions of the rectum, bladder and 
sexual system remain unaltered. There is marked ankle clonus, 
in which the muscles of the calf or the whole limb are put in a 
state of tremor when the foot is flexed, or when the patient puts 



348 A COMPENDIUM OF PRACTICAL MEDICINE. 

his toes to the ground. The patient drags his limbs. The dura- 
tion of the disease extends over many years (Bartholow, Loomis 
and Flint). 

Treatment. — The galvanic current is most useful. Iodide of 
potassium, arsenic and cod -liver oil, with careful attention to 
rest and diet, are to be recommended. Rubbing and massage 
afford great comfort. Calabar bean may be given for the cramps 
(Loomis). 

ANTERIOR POLIOMYELITIS. 

Called also infantile spinal paralysis, is a disease occurring 
in children suddenly, and is due to an inflammation of the an- 
terior cornua of gray matter of the cord. It may, however, occur 
in adults, but much less frequently (Bartholow). 

Causes. — This is a disease of the first three years of life. 
Cold, dentition and traumatism have been assigned as causes. It 
is frequently developed during convalescence from the exanthe- 
mata and other acute febrile affections (Loomis). 

Symptoms. — The usual onset of the disease is a fever which 
lasts a day or two, and on recovery from which it is observed, 
with surprise, that the child is paralyzed. There maybe head- 
ache, pain in the back, and limbs, nausea, vomiting, vertigo, de- 
lirium, convulsions and coma. In some cases the paralysis 
occurs without prodromes. If only one lower limb is involved 
at first, the other soon becomes so, and it is not unusual for all 
four extremities to be affected at once. Sensibility is not affected. 
The bladder may be paralyzed, and the urine retained. Paralysis 
is complete at once, and soon begins to lessen, some restoration 
of power taking place in from one to three weeks. All the 
paralyzed parts may be restored, or one arm and one leg may re- 
main paralyzed. The muscles remaining paralyzed are affected 
permanently, and by a rapidly progressive atrophy. The para- 
lyzed parts become cool, to the touch, and have a blue cyanosed 
appearance. The muscles waste till there is nothing but con- 
nective tissue and fat, and the growth of the limb is arrested. 
The mildest cases recover in a few weeks or in a month or two 
(Bartholow). 



MUSCULAR ATEOPHY. 349 

Treatment. — From \ to 4 grains of quinine and from ^V to \ 
grain of belladonna extract have acted "best according to Bar- 
tholow. Hot douche to the spine, galvanism, and rest, with 
massage and faradism are of service. Strychnia may be injected 
into the paralyzed parts two or three times a week. Tonics are 
clearly indicated (Bartholow). 

PROGRESSIVE MUSCULAR ATROPHY. 

Called also wasting or creeping palsy, is a disease charac- 
terized by a progressive and chronic wasting and atrophy of the 
voluntary muscles due to atrophic changes in the anterior cornua 
of the cord (Loomis). 

Causes. — It is an hereditary disease, and is met with chiefly 
in males. The period of greater liability is between the ages of 
thirty and fifty. The disease may be excited by over -exertion of 
a group of muscles in certain occupations. Injury to the spine 
and exposure to cold and wet are said to excite it. In children 
the disease is invited to the lower limbs by prolonged effort on 
the legs. Exhausting diseases, the poison of lead and syphilis, 
and certain dyscrasise seem to exert an influence in developing 
the disease (Bartholow and Loomis). 

Symptoms. — The disease usually comes on insidiously, the 
first indication of its presence being wasting and loss of power 
of some muscles; as a rule those of the hand are first atrophied, 
then the muscles of the forearms, arms and shoulders. Just 
before wasting begins, the patient will remember that he had 
for weeks or months a feeling of slight numbness or formication, 
and that his fingers have seemed clumsy. The patient complains 
of a sensation of cold air being blown on him. Wandering pains 
frequently precede the wasting of the muscles. A peculiar 
fibrillary tremor is present early (Loomis). 

Prognosis. — Is extremely unfavorable. Its course is slow. 
The average duration is five years. As its name implies, it is 
always progressive (Loomis). 

Treatment. — Bartholow recommends injections of a solution 
of ^ glycerine three times a week into the wasting muscles. A 
descending current of galvanism should be applied to the whole 



350 A COMPENDIUM OF PRACTICAL MEDICINE. 

length of the spine daily, for two minutes. Massage, using with 
friction lard, should consist of friction, kneading and tapping 
the muscles. Hot douches to the spine and rubbing a wet pack 
over the affected members are also highly to be commended. 

MENORRHAGIA AND METRORRHAGIA. 

Menorrhagia is an increased flow of the blood and mucus 
occurring at the menstrual period. 

Metrorrhagia is a flow of blood from the genitalia in the 
inter -menstrual period. 

Causes. — May be general or local. The general causes are 
hemorrhagic diathesis, scurvy, fevers, tuberculosis, super-lacta- 
tion, icterus, Bright's disease, obesity and cachexia. The local 
causes are reflex stimulus from the genital organs or simply from 
nervous derangement, as at puberty, first intercourse or the 
menopause. Reflex stimulation from the mammary glands during 
lactation will cause metrorrhagia. Other local causes are endo- 
metritis, fibromata, cancer, ovarian tumors, and affections of the 
Fallopian tubes (Pozzi). 

Treatment. — The cause should always be sought and treated. 
The local measures are prolonged irrigation of hot water (110° 
to 120° F.) and tampon of the vagina. Astringents, such as 
tincture of iodine with glycerine or Monsel solution diluted, may 
be applied to the endometrium. The general measures are: Rest 
in bed with elevation of the pelvis; opium in the form of lauda- 
num, rectal injections; ergot by the stomach and infusion of 
digitalis leaves. In many cases fluid extract of hydrastis given 
in half- drachm doses every four hours during the time of the 
flow, and in twenty- drop doses before meals in the intervals, is 
very efficient. Oil of erigeron in five -minim capsules every three 
hours is also effective (Pozzi). 

PRESCRIPTIONS FOR MENORRHAGIA. 

R Extract! ergotse fluidi WTix. 

Ammonii chloridi gr. x. 

Sodii bromidi gr. v. — M. 

Sig. : For one dose, to be taken in half tumbler of water ; may 
repeat every two hours. — Goodell. 



MENORRHAGIA MORNING SICKNESS. 351 

R Ext. gossypii fid 

Syr. simplicis aa §j- — M. 

Sig. : A teaspoonful every four hours. — Parvin. 

R Ext. rhois aromat fid %iv. 

Sig. : A teaspoonful every hour for a few doses, then every three 
or four hours. — Shoemaker. 

R Acidi gallici 5ss. 

Acidi sulphurici dil gj. 

Tinctopii deodorat 33. 

Inf. rosse comp Siv. — M. 

Sig.: A tablespoonful, every four hours. — Bartholow. 

R Tinct hamamelis Bij. 

Sig.: One-half to one teaspoonful thrice daily. — Ringer. 

R Ext. ipecac fid gij. 

Ext. ergotse fid siv. 

Ext. digitalis fid 31J. — M. 

Sig.: A half to one teaspoonful as required until emesis occurs. 

— Bartholow. 

R Potassii bromidi 31J. 

In pulv. no. xii. div 

Sig.: A powder in a wineglassful of water three times daily. (In 
flooding of young women who menstruate too often as well as too 
copiously). Begin before the period and continue till it is over. 

— Ringer. 

R Tinct. sabinse ,..Sss. 

Sig. : Five to ten drops in cold water every half to three hours. 

—Phillips. 
MIGRAINE. (See Headache). 

MITRAL DISEASE. (See Valvular Diseases). 

MORNING SICKNESS. 

The nausea and vomiting which occur in pregnant women 
011 waking in the morning are called morning sickness. 

It is due to spasmodic contractions of the diaphragm and 
stomach. It usually recurs daily during the first three months 
of pregnancy and then gradually disappears (Lusk). 

Treatment, — Nearly every drug of the Materia Medica has 
been tried at one time or another for the nausea and vomiting of 
pregnancy. Spraying the pit of the stomach with ether is effect- 
ive in some cases. To many, ice-cold effervescent drinks are 



352 A COMPENDIUM OF PRACTICAL MEDICINE. 

grateful. Lusk orders ten grains of the subnitrate of bismuth 
combined with five to ten grains of oxalate of cerium to be taken 
ten minutes before eating. He also gives ten drop doses before 
meals of the tincture of nux vomica in cases of gastric catarrh. 
Droja doses of Fowler's solution at meal-time are said to exert 
considerable influence in allaying stomach irritability. After 
eating, digestion may be promoted by ten grains of pepsin given 
alone or with dilute muriatic acid. If the vomiting is literally 
uncontrollable, the patient should be placed at rest in bed 
(Lusk). 

PRESCRIPTIONS FOR MORNING SICKNESS. 

j& Cocaini muriatis gr. j. 

Extracti belladonnse — 3vi. — M. 

Sig. : Apply locally to the cervix uteri morning and evening. 

— Fenn. 

Jk Cocaini muriatis gr. j. 

Aquse. g. — M. 

Sig.: A teaspoonful three times daily before meals. — Parvin. 

J% Atropia sulphatis gr. j. 

Morphias sulphatis gr. iv. 

Acidi sulphurici aromat £iij. 

Aquse. 3v. — M. 

Sig. : Ten to twenty drops in water thrice daily. — Boys. 

jfc Cerii oxalatis gr. xxiv. 

Extracti hyoscyami gr. xxxvj. — M. 

Ft. massa et in pil. no. xii. div. 
Sig. : One pill twice daily. — Goodell. 

MUMPS. 

Called also parotitis, or parotiditis, is a constitutional or 
blood disease with local manifestations. It is a specific inflam- 
mation of the parotid gland (rarely are the other salivary glands 
involved), self- limited, and characterized by a tendency to mi- 
grate into the mamma or testes. Parotitis is of two varieties, 
specific and non-specific (Smith and Bartholow). 

Causes. — It occurs chiefly in childhood, youth, and early 
manhood, cases being rare in infancy and old age. It is highly 



3ir:\ips. 353 

contagious, and commonly occurs as an ejrideniic. It prevails 
most in crowded localities and among those who live in cold 
damp cellars. It is probably a microbic disease (Smith and 
Loomis). 

Incubation. — The period of incubation varies from ten to 
eighteen days (Flint). 

Symptoms. — Mumps begins wtih languor and fever, and 
usually chills or chilly sensations. There are frequently dull 
pains in the limbs, loss of appetite, headache and delirium. In 
36 to 48 hours, there is a sensation of stiffness about the angle 
of the jaw, followed by pain and swelling. The pain is in- 
creased by speaking, swallowing and by pressure. The disease 
reaches its height in from three to five days, and the swelling of 
the gland begins to subside on the seventh or eighth day. A 
metastatic orchitis may occur in males after puberty. In females, 
the mammary gland and ovary may become inflamed. It is one 
of the diseases which affect the same person but once. Xon- 
specific parotitis developing during some severe constitutional 
disease, shows a tendency to suppurate from its beginning, and 
discharges laudable pus (Bartholow, Flint, Loomis and Smith). 

Prognosis. — Is favorable in the specific variety; but very un- 
favorable in the non-specific (Loomis). 

Treatment. — Warm applications to the affected parts will 
give relief. Morphine and quinine may be given internally. A 
mild saline cathartic may be administered. The diet should be 
non- stimulating. Inunctions of oil to the swollen gland are 
useful. A mustard foot-bath should be given (Bartholow and 
Loomis). 

PRESCRIPTIONS FOR MUMPS, 

|& Antipyrine 5j . 

Potassii bromidi 5iij • — M . 

In pulvus no. xv. div. 
Sig. : Give one powder in water every three hours till the fever 
abates. — J. Lewis Smith. 

Jfc Hydrargyri cum cretae gr. iv. 

Saccharri lactis gr. xx. — M. 

In pulvus no. xii. div. 
Sig.: One powder three or four times daily. — Ringer. 



354 A COMPENDIUM OF PRACTICAL MEDICINE. 

MYALGIA. 

Called also muscular rheumatism, is a rheumatic affection 
of the voluntary muscles accompanied by pain and tenderness, 
but by no other evidences of inflammation. It has been named 
according to its seat, torticollis (wry- neck), cephalalgia, pleuro- 
dynia, lumbago, etc. (Loomis). 

Causes. — Exposure to cold and damp draughts are often the 
exciting causes of an attack. Over-fatigue and sudden straining 
of a muscle may induce it. Malaria may cause it. It may come 
on suddenly in a rheumatic or gouty subject (Loomis). 

Symptoms. — An attack usually comes on suddenly with 
severe, deep-seated pain in the muscles affected. The pain is of 
a stretching or tearing character, increased by movement or pres- 
sure. It is more severe at night. The pain may shift or remain 
fixed in certain muscles. Certain positions mitigate the pain. 
Lumbago is the severest variety. In all varieties there is pain 
and rigidity of muscles, but no fever or constitutional symptoms. 
The duration of myalgia varies between a few hours and a 
week. The duration of the chronic form is indefinite (Loomis). 

Treatment. — In the young, cod-liver oil acts as a preventive. 
A hot air or Turkish bath will be of service at the beginning of 
an attack. In chronic cases the favorite drugs are arsenic, sul- 
phur, and guaiacum. Quinine is almost a specific in the malarial 
form. The patient should wear flannel and sponge the body 
with cold water every morning. 

In lumbago hot applications and anodyne liniments will 
often give relief. A hypodermic of morphia may be required. 
The constant and faradic currents may give relief (Loomis). 

MANIA=A=POTU. (See Delirium Tremens.) 

MASTURBATION. 

Called also self- abuse or self- pollution, is not a disease. It 
signifies that an orgasm is produced by means of friction with 
the hand. It does not necessarily produce disease unless it is 
carried to excess. Masturbation is not confined to man. 
Monkeys, bears and goats indulge in it. Turkeys practice it 



MASTUKBATIOX. 355 

Tipon a round, smooth stone. In the human being, both sexes 
practice it. Females are much less given to it than males. The 
majority of women have very little passion, and suffer the ap- 
proaches of a lover or husband largely as a matter of complais- 
ance. As a rule, the female learns what passion is only as the 
result of education after marriage. With the male it is different. 
He often has erections in childhood and sexual yearnings long 
before puberty. A boy, when handling himself during erec- 
tion, is apt to find the sensation agreeable and go on until he 
has formed the habit. Male babies are sometimes handled by 
their nurses to keep them quiet, and this begets the habit. Boys 
usually receive instruction from other boys at school, and this is 
the most common incentive. A large proportion of mankind 
have masturbated more or less at some period of life, and it is 
safe to assert that at least ninety per cent, of such masturbators 
are not injured by the habit. Sexual indulgence in the natural 
way will produce evil effects if carried to excess, yet it is proba- 
ble that sexual intercourse is not only harmless, but even bene- 
ficial in moderation. It is not the loss of seminal fluid which is 
of the first importance in producing disease from sexual excess, 
but the nervous shock of the oft-repeated orgasm. 

Babies and young children lose no seminal fluid, women 
have none to lose, yet in all these, evil results follow excesses, as 
certainly as they do in the male after puberty. 

Any succession of nervous shocks as sharp and decisive as 
the sexual orgasm, such as joy or fear, would shatter the vitality 
and nervous tone of an individual as much as masturbation. The 
cunningly conceived advertisements in newspapers, books and 
circulars by quacks, implant errors in the mind concerning this 
vice which years of sober after thought are scarcely able to erad- 
icate. Masturbation is not confined to youth; middle and old 
age are not free from it. The use of tobacco and alcohol in- 
flicts as much injury upon the human race as does the secret 
vice, if both are carried to excess. 

The chief reason why so much is said of venereal excess by 
masturbation, and so little of sexual excess in the natural way, 
is, that the former is so much more common and not that the act 
itself is physically more harmful. The former may be practised 



356 A COMPENDIUM OF PRACTICAL MEDICINE. 

on all occasions, even in company, by the hand in the pocket, in 
bed or in solitary places, but the latter requires the consent of 
two individuals, and opportunities which relatively are hard to 
find (Keyes). 

Symptoms, — A young child who masturbates, has many 
erections, and handles his genitals frequently. Such children are 
fretful, peevish, thin, nervous, excitable and sleep badly. Boys 
who masturbate usually have a long prepuce; they have a sallow 
look, and sheepish, hang- dog expression. They are melancholy, 
sit by themselves, become absent minded, and the innocent frank- 
ness of youth is absent. The young man is over shy, unambi- 
tious, he shrinks from a steady gaze, blushes readily, and seems 
conscious of having done something unmanly and little. Men 
who masturbate often show no sign of the habit, and it is rare 
for them to practice it to excess. In the vast majority of in- 
stances, masturbation does little harm to the individual except 
in regard to his morals. The practice is a base one (Keyes). 

Treatment.- — If a nurse handles an infant she should be dis- 
charged. If the infant has already acquired the habit his hands 
must be tied when he sleeps, and at other times watched. 
Boys should always be made to sleep alone. The best treatment 
is to elevate the boy out of his bad habit, to shame him, to make 
a man out of him, to sympathize with him, and to treat him 
morally. When a man comes complaining of the results of mas- 
turbation, it will be found that he is a hypochondriac, and his 
malady ungratified sexual desire. He should be encouraged and 
advised to marry. Medicines are of little or no value. Cold- 
sponge baths, out- door sports, physical fatigue, sleeping in a cold 
room on a hard bed, with light covering, eating lightly at night, 
and not retiring until very sleepy are all useful in breaking up 
the habit (Keyes). 



MOLES MILIUM. 357 

MILK=LEG. (See Phlegmasia Alba Dolens.) 

MISCARRIAGE. (See Abortion.) 

MENIERE'S DISEASE. (See Vertigo.) 

MOLES. 

Are very common, few people being without one or more 
upon the surface of the body, while many have them in numbers. 
Moles are sometimes congenital, constituting one of the varieties 
of " mother's marks," and sometimes acquired. They occur in 
the shape of circumscribed brown patches, and on the face in the 
gentler sex are often regarded as beauty spots. They are rarely 
of any great importance beyond the disfigurement they produce. 
Occasionally they become the seat of a cancerous disease; the 
melanotic sarcoma has frequently its origin in such congenital 
spots. Many of the most virulent forms of multiple cancer the 
surgeon sees have their origin in moles (Bryant). 

Treatment. — The surgeon should excise any mole that has a 
tendency to grow or become indurated in middle life. When 
they are situated on the face, it is generally desirable to let them 
alone, for if they are small they often adorn it, while if large 
there is risk of leaving scars. They may be removed by caustics, 
such as potassa fusa (Bryant and Anderson). 

MOTHER'S MARK. (See Nsevus). 

MILIUM. 

A milium is a little round slightly elevated, pearly- white 
spot, about the size of a millet- seed or larger. They are scat- 
tered over the surface in variable numbers, but are principally 
met with on the face, especially near the eyes, and on the eye- 
lids (Anderson) 

Cause. — Obliteration of the glandular duct and retention of 
the sebaceous matter is the sole cause. 

Treatment. — Consists in punctuiing the upper wall of each 
milium and expressing its contents (Anderson). 



358 A COMPENDIUM OF PRACTICAL MEDICINE. 

MUSCULAR RHEUMATISM. (See Myalgia). 
MORBUS COXARIUS. 

Is a disease of the hip -joint. 

Causes. — The disease may begin as a synovitis, or it may be- 
gin in a rupture, partial or complete of the ligamentum teres, 
thereby interfering with the nutrition of the head of the femur. 
It may begin from rupture of some minute blood vessels in the 
bone just beneath the cartilage. The synovitis is almost always 
the result of exposure to sudden changes of temperature after 
violent exercise, such as skating, racing, jumping, playing at 
foot- ball and other movements that over exercise the joint. In 
other words morbus coxarius is almost invariably due to a trau- 
matic cause, and not dependent upon some constitutional taint, 
as scrofula, etc. (Sayre). 

Symptoms. — There are three stages: 1. The stage of irrita- 
tion or of limited motion, before the occurrence of effusion. 2. The 
stage of apparent lengthening, or of effusion, the capsule of the 
joint remaining entire. 3. The stage of shortening, or of ruptured 
capsule. The first thing that attracts the attention of the patient 
is generally a stiffness about the joint and a limping gait in the 
morning. In the first stage, there will be slight abduction and 
slight flexion at the knee and hip. Abduction, adduction, and 
rotation are also limited. There is atrophy of the thigh or entire 
limb. There are pain and tenderness. The pain may be re- 
ferred to the knee, and thus mislead the surgeon. In the second 
stage, the pain, tenderness, swelling, atrophy, and limited motion 
of the first stage are increased in severity. The limb is appar- 
ently longer, abducted, everted, and flexed in both joints. The 
foot touches the ground with the sole. The toes are everted as 
in fracture of the neck. The pelvis is lowered on the diseased 
side, and projects forward. The natis is low and flat. The pain 
is most intense. In the third stage, the capsule ruptures and the 
fluid escapes into the surrounding tissues and the patient is com- 
paratively free from pain. The limb is shorter, adducted, in- 
verted, and flexed in the hip- joint only. The foot touches the 
ground with the ball only. The toes are inverted. The pelvis 



jsnevus. 359 

is raised, projected backward, and natis is high and round 
(Sayre). 

Treatment. — Is both local and general. The general treat- 
ment will consist of tonics, cod liver oil, stimulants, good food 
and hygienic surroundings, sunlight and frequent baths. The 
local treatment consists of absolute rest and freedom from pres- 
sure of the parts involved in the disease (extension). If milder 
measures fail, exsection of the joint is justifiable (Sayre). 

NyEVUS. 

Is essentially a disease of the capillaries and is made up of 
a mass of vascular tissue. Nsevi are almost always congenital. 
Some nsevi are pigmentary and are then termed " moles " (Bry- 
ant). 

Situation. — Their commonest situation is in the skin and 
subcutaneous tissue, and occurs on the head and face much more 
frequently than elsewhere. If entirely subcutaneous the skin is 
not discolored, but if the nsevus invade the skin there is a dis- 
coloration of its surface, or a pedunculated outgrowth like a 
piece of cock's comb (Anderson). 

Varieties. — There are three varieties of nsevus — arterial, ven- 
ous, and capillary according as arterioles, veins, or capillaries 
predominate in their structure. Arterial and venous nsevi are 
always congenital and subcutaneous. They may be emptied by 
pressure. The morbid erectile tissue of the venous nsevi resem- 
ble pretty closely natural erectile tissue of the penis and nipple. 
A capillary nsevus called also "mother's mark," " port wine 
mark" or " strawberry mark," is the most disfiguring, but the 
least harmful of the three varieties. It occurs more frequently 
on the head, face, neck, shoulders and arms than elsewhere; and 
consists of bright red or purple patches on the surface of the 
skin. It is sometimes prone to take on unhealthy ulceration. At 
birth these nsevi are often no larger than a pin point, but may 
grow rapidly (Anderson). 

Treatment. — The methods of treatment are various. The 
artery leading to the nsevus may be ligated. The part in which 
the nsevus is situated may be amputated. The nanus may be 



360 A COMPENDIUM OF PRACTICAL MEDICINE. 

injected with various astringent fluids. The actual cautery, 
various caustics and electrolysis have been tried. Multiple 
punctures and scarifications of port wine stains have been em- 
ployed, but it is not very successful (Anderson). For small 
superficial birthmarks, S. D. Gross applies with a brush locally 
sixteen grains of corrosive sublimate to half an ounce of collo- 
dion. Bartholow recommends the following : 

R Acidi chromici ^iss. 

Aquae destillatse §j . — M. 

Sig. : Apply with care locally. 

Waring paints the spot daily with creosote. 

NECROSIS. 

Is the death or mortification of bone, and is applied to cases 
in which part of the shaft of the bone dies. 

Causes. — Injury or violent inflammation. Necrosis of the 
lower jaw frequently results from the inhalation of the fumes of 
phosphorus by persons employed in lucifer match factories. 
The bone in necrosis dies from obstruction of its circulation 
(Bryant). 

Treatment. — The indication is to remove the sequestrum as 
soon as it is sufficiently loose. It may require an incision if the 
dead bone is large (Bryant). 

NEPHRITIS. (See Bright's Disease.) 

NETTLE RASH. (See Urticaria.) 

NEURALGIA, 

Is a functional affection of which the chief characteristic is 
pain. In a purely neuralgic disease there is neither inflamma- 
tion nor any appreciable lesion in the painful part (Flint). 

Causes. — Neuralgia is often an hereditary disease. Any dis- 
ease causing anaemia is a marked predisposing cause. Among 
exciting causes are damp, cold, lead, mercury, traumatism and 
chronic blood poisoning. Reflex neuralgia is induced by genito 
urinary diseases, decayed teeth, dyspepsia, worms, constipation, 



1STETTKALGIA. 361 

etc. Neuralgia may follow or accompany herpes zoster. It is 
rare before puberty, and most frequent between 20 and 50 years 
of age. Women are more liable than men (Loomis). 

Symptoms. — The pain is at first intermitting, later it is con- 
tinuous wuth slight remissions. It may be dull, boring, stabbing, 
tearing, or darting, and is confined to the course of a nerve. 
Turning and coughing increase the pain. Increase of pain on 
pressure is an important point. Tri-facial neuralgia is one of the 
most common forms. It is usually attended with painful spasm, 
called tic douloureux. Clavis hystericus is a variety of tic in 
which there is a sensation as of a nail being driven into the 
skull. It is usually met with in anaemic females. 

Sciatica is a neuralgic affection of the sensory nerves of the 
sciatic plexus. It may be caused by pressure of tumors, by 
caries of vertebrae and by rheumatism as the result of taking cold. 
Chronic malarial infection may be the cause of sciatica. The pain 
is more intense at night. Cramps in the muscles of the legs are 
common. It is a very obstinate affection lasting from six weeks 
to two months, though it may last for years. Relapses are com- 
mon (Loomis). 

Intercostal neuralgia is an affection of any of the dorsal 
nerves; the anterior branches of tw T o or three of the nerves upon 
the left side are those usually affected. It occurs in women as a 
rule. The pain is intermittent, tearing or stabbing in character, 
increased by coughing or sneezing. 

There are three diagnositic points of tenderness; namely, at 
the exit of the nerves from the spine, at the side of the chest 
where they become subcutaneous, and near the sternum or 
median line at the terminal branches. Cardiac palpitation, 
dyspnoea, nausea and vomiting are frequent symptoms of inter- 
costal neuralgia. Herpes zoster, intolerable itching, and attacks 
of angina pectoris often complicate it. 

Cervico- occipital neuralgia is usually attended with pain 
along the course of the occipitalis major, and often resembles that 
form of muscular rheumatism called torticollis, or wry neck. 

Coccyodynia is common in women, and is due to neuralgia 
of the coccygeal plexus (Loomis). 



362 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — Neuralgia lias been well said to be the cry of a 
nerve for better blood. If there be anaemia, a good diet, cod-liver 
oil, the hypophosphites, quinine, iron and strychnia should be 
ordered. Neuralgia due to syphilis demands iodide of potassium; 
to rheumatism, the anti- rheumatics; to gout, colchicum; and to 
malaria, quinine, but in many non- malarial cases also, especially 
in tic, quinine is the most effectual remedy. 

Local Treatment. — Blisters, galvanic current, chloroform, 
opium, belladonna, veratria liniments, and cold or very hot water 
may be applied, and usually these remedies afford relief. Acon- 
ite is an effective remedy applied locally. Firing, sinapisms and 
the actual cautery are frequently beneficial. A warm dry climate 
is favorable. Morphine is the most effective for immediate relief 
of pain. Neuralgic attacks and headache that are accompanied 
by flushing of the face are often relieved by ergot. But when 
the face is very pale, nitrite of amyl is to be preferred. Good 
results are obtained by the use of antipyrin. In severe chronic 
neuralgias a portion of a nerve may be excised. In sciatica 
nerve stretching is effective in some cases (Loomis). 

PRESCRIPTIONS FOR NEURALGIA. 

R Menthol gr. xxiiss. 

Cocaini muriatis gr. viiss. 

Chloral hydratis gr. ivss. 

Vaselini ' ^iiss. — M. 

Ft. ungt. 
Sig. : Apply to the painful part and cover with a strip of court 
plaster. — Galezowski. 

R Menthol 3j. 

Linementi saponis comp §ij. — M. 

Sig.: Use locally. — Witherstine. 

R Quinise sulphatis gj. 

Morphise sulphatis gr. iss. 

Strychnia? sulphatis gr. j . 

Extracti aconiti gr. xv. 

Acidi arseniosi gr. iss. — M. 

Ft. massa et in pil. no. xxx. div. 
Sig.: One pill thrice daily. — S. D. Gross. 



NIPPLES NYMPHOMANIA. 363 

1£ Chloral hydrastis 

Pulv. camphors aa .^iv. — M. 

Sig. : Apply with a camel's hair brush. — Geo. Bird. 

NIPPLES. (Sore). 

Sore nipples are sources of great distress and too often the 
precursors of mammary abscess. 

Causes. — They are doubtless often caused by some aphthous 
condition of the child's mouth, but they frequently result from 
some unusual sensibility of the skin of the part, and at times 
from want of care. A simple erythema, associated with great 
tenderness, is a common trouble at the beginning of lactation to 
which primiparse are more subject than multiparas (Lusk). 

Treatment. — It is a good plan to anticipate this difficulty by 
instructing the patient to wash the nipples daily during the last 
weeks of pregnancy with some astringent or alcoholic solution. 
In child-bed, in addition to strict cleanliness, great benefit is de- 
rived from folding a linen rag around the nipple and keeping it 
constantly wetted with Goulard's extract, a teaspoonful to a 
tumbler of water, until the sensitiveness and redness have dis- 
appeared. Before applying the child to the breast, care should 
be taken to wash away the deposited carbonate of lead. Where 
the nipples are not sufficiently prominent, a breast glass or 
gutta-percha shield should be worn. The apjjlications of glycer- 
ine of tannic acid, Richardson's styptic colloid, tincture of cat- 
echu, a solution of nitrate of silver gr. v. to the ounce of water, 
and an ointment of extract of rhatany gr. viii. mixed with 5. ii. 
of the oil of theobroma, are good applications. Castor oil as an 
external application or collodion is sometimes useful (Lusk and 
Bryant). (See also fissures of the nipples). 

NYMPHOMANIA. 

Is an irresistible sexual desire in females. It is the analogue 
of satyriasis. 

Causes. — As a rule, nymphomania is caused by cerebral 
lesions. It is also a functional nervous affection (Bartholow). 

Treatment. — Twenty grains of the bromide of potassium 
thrice daily will exert a decided control over excessive sexual 



364 A COMPENDIUM OF PKACTICAL MEDICINE. 

propensity (Ringer). As a rule, nymphomania dependent on 
cerebral lesions are not diminished or prevented by the bromides 
(Bartholow). Large doses of camphor (from five to twenty 
grains) diminish the venereal appetite and the vigor of the erec- 
tions, and are therefore useful in priapism, satyriasis, nympho- 
mania, chordee, etc. (Bartholow). There is no doubt that ex- 
cessive use of tobacco lessens the venereal appetite; hence, 
slightly nauseating doses of the wine of tobacco will effectively 
check chordee, priapism, satyriasis and nymphomania (Bartho- 
low). 

NAUSEA. (See Vomiting.) 

NEURITIS. 

Is an inflammation of a nerve or nerves. Varieties: 1. Sim- 
ple neuritis. 2. Toxic neuritis. 3. Diathetic neuritis. 4. Mul- 
tiple neuritis. 

Causes. — Simple neuritis is produced by wounds, injuries, 
and extension of inflammation from adjacent tissues, as an inter- 
costal neuritis is caused by an adjacent pleuritis or tuberculosis 
of the lung; sciatica, by a pelvic abscess or inflamed haemor- 
rhoids. Toxic neuritis is caused by lead, copper, arsenic, etc. 
Diathetic neuritis arises from some systemic condition, such as 
rheumatism, gout, syphilis, etc., and septic diseases. The cause 
of multiple neuritis is not known (Bartholow). Alcohol must 
be recognized as an unquestioned cause, especially of chronic 
neuritis. Exposure to cold and sexual excess are frequent causes 
(Loomis). 

Symptoms. — There may be chilliness followed by fever, 
headache, and general muscular soreness. The most prominent 
symptom is pain in the nerve. The pain is of a very distressing 
kind; it is a burning, tingling, tearing and intense pain, and is 
increased by motion or pressure. At first, there is great sensi- 
tiveness in the inflamed nerve, and ultimately the parts supplied 
by the nerve become anaesthetic, then will follow paresis, and 
finally paralysis, if the nerve is compressed or destroyed. Wast- 
ing and degeneration of the muscles are results of neuritis. 
Various forms of cutaneous eruptions appear, as herpes, eczema 



NEURITIS NIGHTMARE NIGHT -SCREAMING. 365 

and glossy skin; the nails become clubbed, the hair falls out, and 
the joints swell and change in structure. The reflexes are 
diminished (Bartholow). 

Differential Diagnosis. — Neuritis may be mistaken for neural- 
gia. In neuralgia the pain is paroxysmal; there are isolated 
points of tenderness and absence of paralysis. In neuritis the 
reverse (Flint). 

Prognosis. — Is very uncertain. 

Treatment. — In acute cases, leeches may be applied along the 
course of the nerve, if the patient be vigorous. A fall dose of 
morphine and quinine should be given at once (gr. ss.-gr. xv. for 
an adult), and two drops every two hours of the tincture of 
aconite root. In chronic cases the most effective remedies are 
galvanism and morphine. The electric brush, blisters and the 
oleate of morphine may be used locally, and iodide of potassium 
internally (Bartholow). 

NIGHTMARE. 

Is a sensation in sleep, as of a pressure of a weight on the 
chest or stomach, and of an impossibility of speech, motion, or 
respiration, from which one wakes after extreme anxiety, in a 
troubled state of mind (Dunglison). 

Treatment. — The bromide of potassium is the most effective 
remedy for nightmare (Ringer). 

NIQHT=SCREAMING. 

Is a symptom which appears to be allied to nightmare 
(Ringer). 

Treatment, — Bromide of potassium is of great service in the 
treatment of children subject to night- screaming. Children 
from a few months to several years old may be attacked with this 
affection. Sometimes the attack occurs only once or twice a 
week, or it may be repeated several times each night. The 
screaming may last only for a few seconds or it may endure for 
several hours. The child is generally horribly frightened. With 
the screaming and fright, squinting sometimes occurs, which 
after some time becomes permanent. In these cases bromide of 



366 A COMPENDIUM OF PRACTICAL MEDICINE. 

potassium will prevent the screaming and remove the squinting. 
This screaming in children is very generally connected with 
deranged digestion, which should be treated (Ringer). 

NEURASTHENIA. (See Asthenia). 
OBESITY. 

Is the excessive accumulation of fat in the organism. 

Causes. — The accumulation of fat in the organism is the re- 
sult of its incomplete oxidation. It may be due to excessive sup- 
ply or excessive formation of fat. Too abundant ingestion of 
rich food, especially of fat and carbohydrates, leads to obesity. 
The tendency to obesity may be hereditary or acquired. In the 
former it is cured with difficulty; in the latter a suitable regimen 
will accomplish much. The use of alcohol favors the accumula- 
tion of fat by diminishing its normal oxidation (Bartholow and 
Flint). 

Treatment. — In the treatment of obesity, it is necessary to 
withdraw all fats, starches and sugars from the diet. This is the 
method of Mr. Banting, now called Bantingism. Obesity, which 
is frequently diminished by a course of alkalies, is better treated 
by alkaline waters, for at the springs these patients can be in- 
duced, more easily to conform to the plan of exercise and diet 
necessary in these cases. It is stated that the bromides, especi- 
ally bromide of ammonium, diminish the deposition and hasten 
the retrograde metamorphosis of the fat in obesity. Permanga- 
nate of potassium has also appeared to be very serviceable as a 
remedy for an abnormal and excessive deposition of fat. The 
vegetable acids are sometimes taken by young ladies to keep 
down the formation of fat; but it accomplishes this object by im- 
pairing digestion (Bartholow). 

Dr. Neligan states that he has often removed an uncomfort- 
able excess of fat by the use of liquor potassse, without in any 
way injuring the patient's general health. 



OBESITY ONYCHIA MALIGNA. 367 

PRESCRIPTIONS FOR OBESITY. 

Jt Potassii permanganatis gr. vj.-xxiv. 

Aquae destillatae Siij. — M. 

Sig. : A teaspoonful three times a day. — Bartholow. 

J& Liquoris potassae Sij. 

Sig. : A half teaspoonful in milk thrice daily. — Waring. 

(EDEMA. (See Dropsy.) 

ONYCHIA MALIGNA. 

This is a disease of the nail matrix. 

Causes. — It is most commonly found in unhealthy children, 
and as a rule is started by some local injury such as a squeeze 
(Bryant). 

Symptoms. — It commences as a swelling of the end of the toe 
or finger, with redness, heat and pain. These symptoms are 
soon followed by exudation from beneath the nail of a serous 
and often fetid fluid; the nail itself loosens, sometimes falls off, 
or either flattens out or curls up at its edges. In rare instances 
the disease involves the last phalangeal joint or bone. The 
fingers and thumbs of both hands may be involved, and the 
disease may exist for years (Bryant). 

Treatment. — In mild cases, tonics internally and water dres- 
sing externally suffice to bring about a cure. In severe cases, it 
may be necessary to take away nail and soft parts and even the 
extreme phalanx. The application of the powdered nitrate of 
lead to the ulcer has been strongly recommended. The disease 
at times may have a syphilitic origin when it will be wise to 
adopt specific treatment (Bryant). Ringer recommends mercury 
ointment applied for ten minutes every hour, and poultices at 
other times. He also advises nitrate of lead to be dusted on the 
diseased tissues night and morning. Bartholow applies a solu- 
tion of chloral to the part or iodoform in powder or ointment. 



368 A COMPENDIUM OF PEACTICAL MEDICINE. 

OPHTHALMIA. 

Is an inn animation of the eye. It is a severe form of con- 
junctivitis called purulent. 

Varieties. — Ophthalmia neonatorum which occurs in infants 
at or soon after birth, and gonorrhceal ophthalmia which occurs 
in adults (Noyes). 

Causes. — In both classes the disease is essentially the same, 
and originates from a contagion in the great majority of cases. 
This contagion is the gonococcus. 

Ophthalmia Neonatorum. — At birth the eye-lids are al- 
ways agglutinated by the parturient secretions. It is common 
too for the eye -lids to remain red and sticky for a clay or two. 
The great proportion of these simple cases will not require ser- 
ious attention, and will clear up if the eyes be washed with warm 
milk and water, or with a solution of boracic acid several times 
a day. But it is the purulent form clue to gonorrhoea which de- 
mands active treatment. In this form there is swelling of the 
lids w T ith thick yellow secretion issuing from the eyes. The 
cornea may ulcerate (Noyes). 

Prophylaxis, — The importance of preventing this disease will 
be appreciated when it is learned that nearly one third of the 
inmates of blind asylums were made blind by this disease. 
Where there is a suspicion of gonorrhoea, the vagina may be 
washed out for some time before parturition and while labor is 
going on with a three per cent solution of carbolic acid. As soon as 
the child is born, Crede drops a single drop of a two per cent, so- 
lution (gr. x. to Sj.) of nitrate of silver between the licls of each 
eye. Dr. Noyes thinks a one per cent solution will suffice. 

Treatment. — At first when the secretion is watery, cold lotions 
and three per cent, solution of boracic acid may be used. As soon 
as the secretion grows a little thicker, and the swelling of the 
lids grows less, a solution of nitrate of silver (gr. v-gr. x.to Sj.) 
may be applied to the everted lids, carefully avoiding the cornea, 
once in 24 hours (Noyes). Gonorrhceal ojmthalmia in adults is 
essentially the same disease as ophthalmia neonatorum. The 
gonorrhceal poison is conveyed to the eyes through the fingers, 



OPIUM HABIT. 369 

handkerchiefs, towels, etc., from acute or chronic gonorrhcea 
(Noyes). 

Symptoms. — Are hyperemia, swelling of the lids which 
speedily closes them, and at first a thin discharge. The secretion 
in a little time becomes more and more purulent. Ulceration 
of the cornea may occur. 

Treatment. — The patient should go to bed. Four to six 
leeches may be put upon the temple in robust subjects. Con- 
tinuous cold applications must be kept to the eye. Absolute 
cleanliness is imperatiye. Boracic acid four per cent, solution 
must be used to cleanse the eyes. When the secretion becomes 
creamy and distinctly purulent, a solution of nitrate of silver 
(gr. x. to 5j.) may be applied to the everted lids, care being 
taken to avoid the cornea. This is applied once in twenty -four 
hours. Should the cornea become invaded, a solution of atro- 
pine sulphate (gr. ij. to 5j.) should be instilled every three to 
six hours (Noyes). Crede irrigates the eye frequently with a 
solution of corrosive sublimate (gr. j. to Sxij.). 

OPIUM HABIT. 

In chronic opium poisoning, the opium is not always taken 
by the mouth; it may be taken in the form of morphine hypo- 
dermically. Some persons take thirty grains of morphine per 
day. Opium eaters are entirely unreliable. They are chronic 
liars, owing to their incapacity to tell the truth. 

Not all persons will contract this habit, but in a minority of 
people opium is unu&ually pleasant, and these are the persons 
who are most liable to become opium eaters. Opium affects some 
people unpleasantly. Many smoke opium and say they can get 
effects which they cannot get in any other way. The opium 
habit is, as a rule, contracted unconsciously. In order to get the 
effect which we get at first, it is necessary to increase the dose. 
Neuralgic patients often become opium eaters. In some it stim- 
ulates the mental faculties. De Quincey took 320 grains daily 
and wrote beautifully. Opium is a much more dangerous drug 
than alcohol. The opium habit is much harder to break up than 
the alcohol. Any one who takes two grains of morphine or 



370 A COMPENDIUM OF PRACTICAL MEDICINE. 

more in twenty-four hours might be said to have contracted the 
opium habit. In chronic opium poisoning the pupils are usually 
contracted. Later on it takes a large amount to cause this con- 
traction of the pupil. A chronic opium eater is apt to complain 
of pain which varies in location from time to time. 

This is done with a view to justify the taking of opium. 
Such patients are great seekers of sympathy; are subject to 
vomiting. At first opium is apt to cause constipation, but later 
on, if continued, it usually causes diarrhoea. An obstinate form 
of diarrhoea should always create suspicion (A. A. Smith). 

Diagnosis. — Always examine the urine or perspiration for 
opium. A very small quantity in these fluids may be detected. 
This should be done when the patient will not own up (Smith). 

Results. — The chronic opium habit will destroy a man men- 
tally, physically and morally. Renal disease is very apt to 
develop sooner or later because of changes in the nervous system. 
Myocarditis of a sub-acute character is apt to develop. Pneu- 
monia in such cases is apt to be fatal. Opium causes a man to 
become old while yet young. It hastens degenerative changes. 
There is oedema in the lower extremities usually in chronic 
opium eaters. It destroys the will power (A. A. Smith). 

Treatment. — Two methods of curing the habit may be 
adopted : 1. Cut it off short. Prof. Flint advocated this 
method most of his life, but altered his opinion later. 2. Grad- 
ually withdraw the drug. This is the best method. When we 
think we are getting the patient down to two grains a day (from 
thirty grains per day), he is probably taking a great deal more. 
If such a patient who is thought to be taking a small amount of 
opium feels well and does not complain of any inconvenience, we 
may know that he is deceiving us. He will even bribe his nurse. 
It requires the most careful watching in such cases, else he will 
deceive us. The more rigid and positive we may be the better 
for the patient. If the patient has been taking 30 grains per 
day, Prof. Smith always tries to get him down to one grain per 
day in 30 days. Should keep the patient under treatment for at 
least six months. Build up and improve the digestion as the 
dose of opium is reduced. The horrors which opium-eaters 
suffer when the drug is withheld are well known; so great, 



OPIUM HABIT ORCHITIS. 371 

indeed, is the suffering that few have sufficient resolution to re- 
linquish it. Ringer thinks that moderate indulgence of the 
habit is not perhaps more prejudicial to health than tobacco - 
smoking. 

PRESCRIPTIONS FOR OPIUM HABIT. 

R Ext. cannabis indicse Sij. — (Squibb). 

Sig. : A teaspoonful every hour or two, as required. (For rest- 
lessness). — Mattison. 

R Zinci oxidi / gss. 

Syrupi simplicis q. s. 

Ft. massa et in pii no. xxx. div. 
Sig. : One pill once daily increasing to tolerance. (For vomit- 
ing and diarrhoea). — DaCosta. 

R Spartein sulphatis gr. j. 

Aquae destillata? 3j . — M. 

Sig.: Ten minims hypodermically, for the collapse produced b}^ 
withdrawing the drug. — Ball. 

R Tincturse nucis vomicae gtt. xij. 

Acidi phosphorici dil gtt. xx. 

Syr. pruni Virg gss. — M. 

Sig. : To be taken twice daily. 

ORCHITIS. 

Is an innammation of the testicles. 

Causes. — True orchitis is very uncommon. As corurjlicating 
mumps, no rational theory has been advanced to account for it. 
Orchitis due to mumps is most often observed at about the age 
of puberty. It occurs in about five per cent, of the cases. It 
comes on near the end of the first week of the mumps and is us- 
ually confined to a single testicle. The affection runs a quick 
course of about a week or ten days, and usually clears up. 
Orchitis after severe injury to the testis is not uncommon. It 
tends to terminate in abscess or gangrene. Orchitis as a result 
of cold is possible. Excessive sexual excitement has been ad- 
duced as a cause. It may complicate variola, typhoid fever and 
gout. Orchitis may come on secondarily during epididymitis 
(Keyes). 



372 A COMPENDIUM OF PRACTICAL MEDICINE. 

Symptoms. — In true orchitis the increase in the size of the 
testis generally advances rather slowly. The pain is often ex- 
cruciating, and always out of proportion to the amount of 
swelling. It has been compared to renal or hepatic colic. No 
position gives rest and any handling of the organ is liable to in- 
duce syncope. If the pain suddenly ceases, it may mean mortifi- 
cation of the organ. The shape of the testicle is rarely altered 
in orchitis. The organ feels indurated. 

Terminations. — It may terminate in gangrene, in complete 
resolution, or in atrophy. The general symptoms are often 
severe; chills, high fever, anorexia, nausea, vomiting, hiccough, 
constipation, sleeplessness, anxiety and nervousness (Keyes). 

Prognosis. — Is always grave. 

Treatment. — The patient should be put to bed, with the 
testicle supported in a sling. If the case is seen early, ten to 
fifteen leeches may be applied in the neighborhood of the 
abdominal ring. The testicle may be enveloped in strong bella- 
donna ointment, or a paste composed of powdered opium and 
glycerine, or if the pain be not too excruciating, in a light tobacco 
poultice. Saline cathartics should be given. The diet should 
be low, non- stimulating, and easily digested. On the slightest 
susjjicion of gangrene, it is wise to resort to subcutaneous section 
of the tunica albuginea to take off tension. If abscess form it 
should be opened (Keyes). 

PRESCRIPTIONS FOR ORCHITIS. 

R Tincturse Pulsatillas 5ss. 

Sig. : One to three drops every hour or two in water. — Brown. 

R Antimonii et potassii tart gr. j. 

Aquae Sviij. — M. 

Sig.: One or two teaspoonfuls every hour or two. — Ringer. 

R Morphias sulphatis gr. xvj. 

Hydrargyri oleatis (10 per cent.)..5ij. — M. 
Sig.: Apply twice daily. (To remove induration). — Marshall. 

R Tincturse iodi §ss. 

Sig.: Apply to swollen testicle after acute symptoms are over. 

— Bartholow. 



otitis. 373 

ft Sodii salicylates 3ss. 

Syrupi simplicis §ij. 

Aquae menthse pip ad §vj. — M. 

Sig. : A tablespoonful every hour till the pain is relieved, then 
every four to six hours. — Pigornet. 

OTITIS. 

Is an inflammation of the ear. If the inflammation is con- 
fined to the external ear, it. is called otitis externa; if confined to 
the middle ear, it is called otitis media; if to the internal ear, 
otitis interna. 

Otitis externa is an inflammatory affection of the external 
auditory meatus involving the cutaneous tissues of that canal, 
the periosteum of the osseous part of the canal, and the mem- 
brana tympani (Purves). 

Causes. — Irritation or injuries to the ear, the prolonged use 
of injections, the pressure of foreign bodies, the passage of cold 
currents of air or water, the non- drying of the ear after washing, 
the presence of fungi, and anything which will cause congestion 
or irritation, are causes. 

Symptoms. — The patient conrplains of a continual itching 
sensation with a feeling of heat and dryness in the canal. There 
is a feeling of fullness in the ear. The discharge is at first 
watery, but finally becomes purulent. 

Treatment. — Discover and treat the cause. Frequent injec- 
tions of warm water are useful. If there are foreign bodies 
present remove them. Prevent the formation of pus. 

Otitis media is an inflammation of the middle ear. The 
symptoms are acute pain and fever. It is nearly always followed 
by perforation of the membrane. The treatment is to evacuate 
the pus as soon as formed. Leeches, opiates, purgatives and 
warm water injections into the meatus are usually found suc- 
cessful. When the discharge occurs, the ear should be syringed 
with lukewarm water to which is added an antiseptic (Purves). 



374 A COMPENDIUM OF PRACTICAL MEDICINE. 

OTALGIA, 

Is a neuralgia of the ear. 

Causes. — When a patient complains of pain in the ear, and 
no innanimation is found either in the external or the middle 
ear, the teeth should be suspected as being at the root of the 
trouble. In the majority of cases of otalgia, sufficient dental disease 
is found to justify the belief that this is the primary cause, and the 
otalgia simply a reflex condition. The cause of otalgia m?v be 
malarial, rheumatic or syphilitic (Buck). 

Treatment. — If the cause of otalgia be a carious tooth, it 
should be extracted or properly filled. In any case discover the 
cause and treat it. 

PRESCRIPTIONS FOR OTITIS AND OTALGIA. 

R Morphise muriatis gr. v. 

Atropise sulphatis gr. j . 

Olei olivas 3j. 

Glycerinae ^iss. — M. 

Sig. : Five drops in the ear every hour till relieved (Otalgia). 

R Acidi carbolici 3j. 

Glycerinse £ix. — M. 

Sig.: A few drops in the ear three times daily. =Hartmann. 

OXALURIA. 

When oxalate of calcium occurs constantly in the urine, it 
produces the so-called oxaluria or oxalic acid diathesis, and is 
apt to lead to the formation of the mulberry calculi and in time 
exert its poisonous effects on the brain and S23inal cord (Loomis). 
Sometimes the crystals appear accidentally in the urine from the 
free use of rhubarb or tomatoes. Disturbed or exhausted nerve 
power and imperfect digestion, nervous prostration produced by 
excessive venery and over stimulated or ungratified sexual desires 
are associated often with oxaluria (Keyes). 

Treatment. — If enough of any alkali be given to render the 
urine abundant and limpid, the oxalate of lime will occasionally 
<li>appear for a time. Baths are beneficial. The true curative 
treatment is purely hygienic and based upon a correct apprecia- 



OXALURIA OZGEXA 



375 



tion of the causes. The mineral acids and strychine seem some- 
times to do good as tonics; an outdoor life sometimes cures 
(Keyes). 

PRESCRIPTIONS FOR OXALURIA. 

R Acidi nitro-muriatici dil ^ij.-iij. 

Tinct. gentianae comp 

Tinct. cinchona? comp. — aa Sj. 

Elixir curacoa ad Siij. — M. 

Sig. : A dessertspoonful in a wineglassful of water thrice daily. 

— Ringer. 

B Glyceriti pepsins Siss. 

Acidi lactici ad 5 ij • — M. 

Sig. : A teaspoonful after meals. — Bartholow 

OZ(ENA. (See also Catarrh, Nasal.) 

In chronic nasal catarrh, if the mucous membrane is 
destroyed by ulcerations, and caries of the bones has occurred, 
the case is then called ozcena. 

The morbid process extends through the nasal passages and 
into neighboring cavities. The discharge consists of a greenish, 
offensive pus, or of scales taking the form of casts of the bones 
which are also offensive from decomposition (Bartholow). 

The disease is very obstinate and hard to cure. The follow- 
ing prescriptions may be tried: 

R Sodii biboratis 

Ammonii chloridi — aa gr. xx. 

Potassii permanganatis gr. x. — M. 

Sig. : To be dissolved in one pint of tepid water and used thrice 
daily with a syringe or douche. — Sajous. 

R Extracti hydrastis fluidi Sij- 

Sig.: Five minims in water three times daily. Also add one 
teaspoonful to half a pint of tepid water and use as a lotion for syr- 
inging the nares. — Bartholow. 



376 A COMPENDIUM OF PRACTICAL MEDICINE. 

ONANISM. (See Masturbation.) 
OXYURIS VERMICULARIS. 

Called also thread worm from its resemblance to pieces of 
ordinary white sewing thread, also seat -worm "from its habitat, is 
frequent in childhood and not infrequent in the adult (Smith). 

Size. — The length of the male oxyuris is about one -fourth of 
an inch; that of the female about one -half inch. They are cylin- 
drical and taper to both extremities. 

Habitat. — The habitat of the oxyuris is the large intestine 
of man, especially the rectum, and they insinuate themselves into 
the folds of the mucous membrane and skin at the margin of the 
anus. They migrate into the vagina and upward into the large 
intestine and lower part of the ileum in great numbers. The 
eggs are oval, each female containing about 10,000. All their 
stages of development take place within the intestinal canal. 
The ova enter by means of the food or directly through personal 
contamination (Bartholow). 

Symptoms. — They excite by their presence in the rectum an 
intolerable itching, sometimes severe pain, tenesmus usually, and 
these sensations are propagated to the genito- urinary organs. 
The itching is most troublesome at night, when warm in bed. 
The stools are usually relaxed, fetid and coated with mucous. 
The skin about the anus is reddened. Various reflex phenomena 
are induced by the irritation of the worm such as epilepsy, 
chorea, catalepsy, etc. (Bartholow). 

Treatment, — Santonine aided by calomel should be first 
given. As soon as this has acted, the bowel should be irrigated 
by a weak decoction of quassia or of aloes. If the vagina is in- 
fested, it must be irrigated with the same solution. The next 
step consists in carefully sponging out all the folds and crevices 
of the anus and perineum and the external genitals also with a one 
per cent, solution of carbolic acid. Vix has found water and 
castile soap to be the most effectual enema. A variety of sub- 
stances administered by injection will speedily destroy thread- 
worms. Thus a teaspoonful of common salt in solution, or a 
drachm of sesqui -chloride of iron in a pint of water are very ef- 



0XYURIS VERMICULARIS OPACITIES IN EYE. 377 

ficacious; so is lime water, solution of alum and in fact any sub- 
stance which coagulates the albumen of the worms (Bartholow 
and Ringer). 

PRESCRIPTIONS FOR OXYURIS VERMICULARIS. 

jfc Santonini gr. xij. 

Olei theobromse 3J . — M. 

Ft. suppositdria? no. iv. 
Sig. : One at bed time introduced into the rectum. — Hartshorne. 

j& Tinct. rhei gtt. iij. 

Tinct. zingiberis ..gtt. j. 

Magnesii carbonatis o v. 

Aquae giij. — M. 

Sig.: This dose should be taken three or four times daily ac- 
cording to the effect on the bowels. — Martin. 

R Sodii chloridi 3x. 

Aquas 3vi. — M. 

Ft. sol. 
Sig.: To be injected by the rectum. — Eillard. 

R Tinct. ferri chloridi ...gss. 

Aquae Oj.— M. 

Sig.: One fourth to one third as a rectal enema. — Ringer. 

OPACITIES IN EYE. 

The opacity is a cloudiness in the transparent media of the 
eye. 

Causes. — The causes are various. They result from ulcera- 
tions, burns, injuries, inflammation from excision of a pterygium, 
etc. 

Discovery. — To discover a very faint opacity, one must use 
oblique illumination in a dark room or examine with the ophthal- 
moscope and feeble light. A plain mirror having behind it a 
convex glass of three inches focus will do the best service. Dis- 
tant vision is always more disturbed by faint opacities than near 
vision. A well defined opacity partially covering the pupil is 
much less damaging to vision even if dense, than a faint haze 
with filmy edges (Novesi. 



378 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — The more recent the opacities the more likely 
are they to improve. So long as blood vessels remain in their 
vicinity the improvement will continue. The restorative action 
will go on for months. The treatment consists in stimulating 
applications. The most serviceable are: very finely powdered 
calomel dusted daily into the eye and which is especially suited 
to children; ointment of yellow oxide of mercury (gr. ij-x to the 
o. j.) to be used every night, or once in two or three nights, ac- 
cording to susceptibility: astringent drops in various strengths, as 
sulphate of zinc, alum, sulphate of cadmium, tannin in glycerine 
(5. ss. to o. j.) tincture of opium diluted 1 to 10, solution of 
iodide potassium, 1 to 3; common salt 1 to 5 or 20; hot fomenta- 
tions: powdered sugar, molasses, etc. The object is to irritate 
and cause hyperemia, not to last longer than a patient can toler- 
ate. Opacity will grow fainter for at least a year. When no 
further absorption is possible and a dense opacity exists, two 
proceedings remain, and they are often combined, namely, iridec- 
tomy and tattooing. An artificial pupil should, as a rule, never 
be made during the recent stage of an opacity unless very dense 
and extensive. When the pupil is covered or the iris is pro- 
lapsed and a marginal part of the cornea is more or less clear, an 
iridectomy will be in place. The spot at which a pupil is to be 
placed is frequently not a matter of discretion because there may 
be only one clear region. If a choice is possible the lower seg- 
ment of the corneals to be preferred to the upper. Very dense 
opacities which are a blemish both to sight and to personal ap- 
pearance may be tattooed with India ink. The fine and expen- 
sive quality of ink is to be used. A bit of the ink j3aste equal 
to the size of the spot to be colored is placed upon the cocanized 
cornea. Numerous and rather forcible pricks with a bunch of 
needles driven obliquely in various directions will force the ink 
under the epithelium, and if it be thick enough one sitting may 
be sufficient (Noyes). 

OVERWORK, 

Treatment. — When there is sleeplessness caused by worry or 
over-work, or that occurring at the menopause, or from men- 
strual disturbances, the bromide of potassium in twenty grain 



(ESOPHAGEAL OBSTRUCTION. 379 

doses at night is invaluable. A drop of laudanum with two of 
tincture of nux vomica, three or four times a day, will relieve the 
distressing symptoms of hysterical women or nervous over- 
worked anxious men. Persons in broken health from over-work 
are benefited by A to ^o of a grain of phosphorus, thrice daily 
for several months. A sitz-bath for ten minutes at 70° to 80° on 
return from business tired and irritable, and one-half hour before 
dinner is highly beneficial (Ringer). 

(ESOPHAGEAL OBSTRUCTION. 

As its name implies, is an obstruction of the cesophagus in 
any part of the tube from whatever cause. 

Causes. — When a patient complains of difficulty in swallow- 
ing, or rather the difficulty in passing food onward down the 
cesophagus after the act of swallowing has been performed, and 
of its subsequent return into the mouth, the surgeon in looking 
for the cause should first think of thoracic aneurism, then of 
cancer of some portion of the tube, and lastly of syphilitic or 
simple ulceration. He should a] so always inquire into the his- 
tory of the case, as to whether the patient sustained any local 
injury from the swallowing of a foreign body, of boiling water, 
or of corrosive fluid. If injury and aneurism can be excluded, 
there is little doubt that the true cause is cancer (Bryant). 

Symptoms. — So long as solid food passes, the patient is 
hardly aware of any obstruction existing, and seldom consults a 
physician. The first symptom that attracts notice is the regurgi- 
tation of food. As the disease advances some sign of ulceration 
may appear, such as the discharge of pus or blood, which usually 
comes up with the regurgitated food, and when this occurs there 
is no better indication of the presence of ulcerative action. If 
the patient be middle-aged, the probabilities of the disease being- 
cancer are very strong; and should there be any local thickening 
behind the larynx or glandular enlargement, the probabilities 
are enhanced. The following case which occurred in a patient 
of the writer illustrates the above very forcibly. The patient, 
aged 53, was dying from starvation caused by inability to swal- 
low on account of obstruction of the (esophagus. By question- 



380 A COMPENDIUM OF PRACTICAL MEDICINE. 

ing it was learned that the trouble had commenced nine months 
before. There was no history of injury. Upon examination 
there was found a thickening behind the larynx and enlargement 
of contiguous lymphatic glands. All liquids or solids swallowed 
by the patient were immediately returned into the mouth together 
with pus and stringy mucus. The patient died seven days after 
the examination. The autopsy showed almost a complete closure 
of the oesophageal tube in its upper third due to cancer. 

Treatment. — The treatment by dilatation must be looked 
upon as a dangerous measure, except when the stricture is of the 
cicatricial form, the passage of an instrument in cancerous or any 
ulcerative disease being likely to hasten the fatal termination by 
causing perforation of the ulcer into the air passages or pleura. 
In these cases fluid nourishment should be taken. When 
swallowing becomes impossible, a fine flexible tube may be passed 
through the stricture. The powers of the patient may be kept 
up by nutritious enemata. When all these means fail, the ques- 
tion of opening the stomach by an operation must be enter- 
tained. Billroth recently has cut down upon the oesophagus and 
excised the cancerous growth but without success; the operation 
is commended to our consideration only by the eminence of the 
surgeon who performed it (Bryant). 

PALPITATION OF THE HEART. 

Is a functional disturbance of the organ characterized by 
increased rapidity of movement, with more or less irregularity of 
rhythm (Bartholow). 

Causes. The heart has a power of independent motion, 

motor apparatus, but it also receives force from the great 
centres. To maintain the movement at a uniform rate, there is a 
regulator apparatus, designed to prevent overaction or to inhibit. 
Besides this mechanism for evolving force and applying it so as 
to produce uniform results, the action is affected by the state of 
the vessels, by the density of the blood, by the movements of the 
respiratory organs, and by the functions of animal life. Hence, 
to maintain the action of the heart, there are: 1. A motor 
apparatus — motor ganglia — situated in the substance of the 



PALPITATION OF THE HEART. 381 

heart. 2. Excitors of activity, branches from the cervical sym- 
pathetic, and also from the spinal cord, irritation of which in- 
creases the movements of the heart. To regulate the movements 
of the heart, there are : 1. The pnenmogastric, irritation of 
which may arrest the heart in diastole. 2. The depressor nerve 
of Ludwig, 'which acts by dilating the blood vessels. The 
fibres of the sympathetic, dilator and constrictor, affect the work 
of the heart by increasing or lessening the tension at the peri- 
phery. The direct cause of palpitation is over- stimulation of the 
cardiac muscle or the excitability from functional derangement 
of the pnenmogastric, or cardiac ganglia, which is either induced 
bv direct or reflex causes. Muscular exercise, breathing rarefied 
air, as in the ascent of mountains, and blows on the epigastrium 
may cause it. Mechanical interference with the movements of 
the organ, as contracted chest, thoracic effusions, tumors of the 
mediastinum, flatulence, distension of the stomach and atheroma 
of the arterial system generally may induce it. Moral and emo- 
tional causes, as grief, hope, anxiety, fear, excessive mental 
effort, etc., increase the action of the heart. Various reflex 
troubles have the same effect, such as uterine disease, gastralgia, 
worms, etc. Palpitation is a very frequent symptom in states of 
debility or anaemia. The cardiac ganglia are rendered irritable 
by the excessive use of tea, coffee, tobacco and spirits. Sexual 
excesses, enervating habits, diabetes, sudden shock or fright, 
chorea or derangements of the digestive organs may cause it. 
Gout, chronic disease of the liver and Grave's disease may be ac- 
companied by palpitation (Bartholow and Loomis). Palpitation 
may accompany organic cardiac disease (DaCosta). 

Symptoms. — The normal cardiac impulse is so slight that the 
motion is not perceptible, unless the hand be applied to the 
precordial space. Whenever a person becomes sensible of the 
beating of his own heart, he may be said to have cardiac palpi- 
tation. The cardiac impulse is unnaturally strong, and the 
action of the heart unnaturally rapid, which may be irregular or 
intermitting. Sometimes there is a loss of three or four beats 
which causes a sense of oppression, or even of impending death. 
Palpitation may be accompanied by a choking, paroxysmal, 
fluttering: sensation. The heart-sounds may be audible to the 



382 A COMPENDIUM OF PRACTICAL MEDICINE. 

patient when he lies on his left side. There may be precordial 
pain or anxiety. The carotids throb. The attack may last from 
a few minutes to some hours, or a day. There is dyspnoea. The 
heart seems almost to tnrn over, to rise np into the throat. The 
patient cannot lie down. There may be vertigo, faintness and 
flashes of light. The face may be pale or flushed. Speech is 
difficult. At the end of the paroxysm a quantity of pale, limpid 
urine is usually passed. Dr. Cotton reported a case in which the 
pulsations were 240 per minute, and ceased on the evacuation of 
of a tape -worm (Bartholow and Loomis). 

Differential Diagnosis. — Cardiac palpitation independent of 
organic disease of the heart may be mistaken for cardiac palpita- 
tion depending upon organic cardiac disease. The former comes 
on suddenly and is not constant; the latter comes on slowly and 
is persistent. In functional palpitation, all the physical signs of 
organic cardiac disease are absent. Palpitation of organic heart 
disease is increased by exercise (Loomis). 

Prognosis. — Is always good in functional cardiac palpitation, 
but may cause the patient great uneasiness (Loomis). 

Treatment. — Discover and remove the cause. Tea, coffee, 
tobacco and alcoholic stimulants must be given up. Errors of 
digestion, reflex disturbances and curable diseases must be cor- 
rected at once or cured. Anaemic subjects should take iron 
in large doses for a long period. The body should be sponged 
night and morning in cold water. In the absence of any explan- 
ation of the paroxysms, the presence of a tape worm maybe sus- 
pected. For the immediate relief of the attack, there is no 
remedy so efficient as the hypodermic injection of morphia. If 
the surface is pale and the extreme vessels contracted, inhalation 
of nitrite of amyl (two to three drops) affords prompt relief. 
The application of the ice-bag to the precordial region is an 
effective means of quieting the heart. The galvanic current, 
from ten to thirty elements, passed through the pneumogastric 
and cervical ganglia of the sympathetic, often gives great relief. 
Chloral, the bromides, camphor, asafcetida, and valerian are 
sometimes useful. Digitalis should never be given in purely 
nervous cardiac palpitation. The physician should assure the 



PARALYSIS. 383 

patient that there is no danger attending the paroxysm of func- 
tional cardiac palpitation (Bartholow and Loomis). 

PARALYSIS. 

Is the loss of muscular contractility, and, as a consequence, 
of the power of motion. The term is also applied to the loss of 
sensibility. The former is motor and the latter sensory 
paralysis. 

Paralysis is not a disease, but a symptom. A slight incom- 
plete paralysis is called paresis. 

Origin and Extent. — Paralysis is nearly always of nervous 
origin. It may be general or partial. It may affect the majority 
of the muscles of the frame, or be limited to one muscle. It may 
be strictly confined to one side (hemiplegia), or exist solely in 
the lower half of the body (paraplegia). It may be complete 
or incomplete. It may come on rapidly or slowly (DaCosta and 
Flint). 

Causes. — Paralysis may be neuropathic or myopathic. A 
myopathic paralysis depends on a primary morbid condition of 
the muscles paralyzed. Neuropathic paralysis depends on either 
a morbid condition of the nerve centres or nerves. The neuro- 
pathic is divided into central and peripheral paralysis. Central 
paralysis depends on morbid conditions seated in either the 
brain or spinal cord, and are divided into cerebral and spinal. 
Peripheral paralysis depends on morbid conditions affecting the 
nerves at any point between their terminations and their central 
connections with either the brain or spinal cord. 

The causes may be thus summed uj) : 

1. Paralysis due to a lesion or any morbid condition of the 
nervous centres as hemorrhage into or softening of the central 
nervous textures, and certain diseases of the brain and spinal 
cord. To this class must be added the functional palsies which 
depend upon a functional derangement of the great centres of 
innervation, such as hysterical paralysis, and that occurring after 
overwork or excesses, and from nervous exhaustion. 

2. Paralysis due to a lesion in the course of a .nerve, such 
as a wound or compression. Palsy from this cause is local, and 



384 A COMPENDIUM OF PRACTICAL MEDICINE. 

is apt to show morbid nutritive changes in the affected part, such 
as glossy fingers and swollen joints, and to be associated with 
pain. 

rS. Paralysis due to an affection of the nerves at their ex- 
tremities, such as exposure to cold. Peripheral palsies lead 
quickly to atrophy of the muscles. 

4. Paralysis due to reflex action, such as irritation of the 
dental nerves in teething children, disorders of the intestines 
both in adults and in children, or disease of the bladder, urethra, 
prepuce, uterus, lungs, plura, or irritation of the nerves of the 
skin. In these cases, the paralysis is produced through the reflex 
centres, which reflect the irritation communicated to them to 
parts healthy in themselves. How else can a wound of a nerve 
on one side of the body lead to palsy on the other ? Reflex 
paralysis is rarely of long duration. 

5. Paralysis due to serious interference with the circulation 
as after the ligation of a large artery. 

6. Paralysis due to a morbid state of the muscles, as certain 
forms of rheumatic palsy and of muscular atrophy. 

7. Paralysis due to the presence of poison in the system, 
such as lead, arsenic, mercury, alcohol, sulphuret of carbon, ma- 
larial poison, and the poisons of rheumatism, gout and acute 
diseases (DaCosta). 

Condition of Paralyzed Parts. — The nutrition and secretion 
are disturbed and the circulation is sluggish. They are fre- 
quently swollen and cedematous, the pulse is weaker than in the 
sound members, and the sensation is impaired, the nails grow 
slowly, so do the hairs, the perspiration is defective, the skin 
feels cold and is prone to break. The muscles may be relaxed 
or rigid, and diminished in size. 

The mode in which palsies are investigated at the bed side. 
We must notice the size, appearance said feel of the stricken part. 
Then we test the sensibility to contact, to tickling, to pinch- 
ing, to cold and to heat; we measure the tactile sense by the 
M'slhcsiometer and note the reflex movements. We next contrast 
the muscles and their motion with the healthy side. We test the 
power by the grasp and by other means. But the most valuable 



PARALYSIS. 385 

agent to judge of the state of the muscle is electricity. We 
should compare the contractions of the sound side with those of 
the diseased (DaCosta). 

Differential Diagnosis. — There are certain points of difference 
in the effects of cerebral, spinal and peripheral paralysis. In 
cerebral paralysis the reflex excitability of the affected muscles 
is retained and may be increased. The electro -muscular con- 
tractility is intact in cerebral palsies. The muscles do not 
speedily become atrophied. The cutaneous sensibility is often 
undiminished. In spinal paralysis, the paralyzed muscles do 
not retain their reflex and electrical excitability; but there are 
exceptions to this. Sensibility may be retained, diminished or 
lost. There may or may not be trophic disturbances. In pe- 
ripheral paralysis the reflexes are generally diminished. The af- 
fected muscles undergo rapid trophy, and the nerves and muscles 
take on the action of degeneration. Peripheral paralysis may 
be the result of syphilis or diphtheria. In all cases of paralysis 
we must get the history of the case (DaCosta andFlint). 

" Paralysis from Commotion" — Cases in which paralysis 
occurs after a variable period dating from railway accidents, 
have been described especially by Erichsen. These cases have 
been considered as important in a medico -legal point of view. 

GENERAL PARALYSIS. 

Exclusive of general cerebral paralysis, general paresis, or 
paralysis of the insane, general palsy dependent upon morbid 
conditions of the brain is rare. 

Causes. — It may be a result of two attacks of hemiplegia, 
the first attack affecting one, and the second the other side. 
Hemorrhage into the central portions of the pons or bulb may 
give rise to double hemiplegia, or general palsy. In the great 
majority of cases general paralysis is spinal. The seat in the 
spinal cord is to be inferred whenever cranial nerves are not in- 
volved and there are no symptoms denoting cerebral disease. 
General spinal paralysis is incident to inflammatory and struc- 
tural affections of the spinal cord and its meninges. In rare in- 
stances it follows diphtheria, and is sometimes connected with 



386 A COMPENDIUM OF PRACTICAL MEDICINE. 

hysteria. It may be caused by exhaustion and exposure to cold. 

Spinal hemiplegia, with motor paralysis on one side and 
anaesthesia on the opposite side, probably always implies a lesion 
limited to the half of the cervical portion of the cord on the side 
of the motor paralysis. 

Paralysis may affect the upper limb of one side and the 
lower limb of the other side; and may be produced by lesions 
situated at the crossing of the pyramids in the bulb. 

In hemiplegia or one sided palsy, the face may be paralyzed 
on the same side as the rest of the body, and the reason of this 
lies in the fact that the facial nerves decussate. Should, then, 
the lesion be situated in the brain above this crossing, both face 
and body are paralyzed on the opposite side to the diseased spot. 
Should, however, the lesion involve the facial nerve -fibres at a 
point below or after the decussation, there will be paralysis of 
the face on one side; and of the limbs on the other. This is 
cross paralysis, and is always indicative of a lesion of the pons 
Varolii. 

Paralysis may come on suddenly or gradually. A sudden 
paralysis almost always has its origin in an apopletic effusion, 
cerebral embolism, and softening. A gradual development of 
palsy indicates some chronic cerebral disorder, such as softening, 
a tumor, or any affection compressing the nervous substance. 

Monoplegia is a paralysis of a muscle or a set of muscles, of 
one limb, or of one side of the face. 

/ 

PARAPLEGIA. 

Is paralysis of the lower half of the body. 

Causes. — Its almost invariable cause is a lesion of the spinal 
cord. Exhaustion, exposure to cold, sexual excesses, hysteria, 
diphtheria, syphilis, poisons, small clot in the pons, injury to 
cord, spina-bifida, tumors, shock and concussion of the spine are 
the principal causes (DaCosta, Flint and Loomis). 

Treatment. — Of remedies having direct reference to the para- 
lysis, electricity holds the first rank. When the paralysis is due 
to diseases involving inflammation, we must not apply the cur- 
rents until the proper time. Frictions, massage, kneading and 



PARALYSIS PARAPLEGIA. 387 

stimulating liniments are nseful. Of drugs, strychnia or nux 
vomica and phosphorus are to be recommended. The cause in 
each should be removed if possible. Strychnia is contraindicated 
in the cases of hemiplegia when the injury to the brain or cord 
has been recent. It generally does no good, but harm, when the 
paralyzed muscles are rigid. In local paralysis, the solution of 
strychnia should be thrown into the substance of the paralyzed 
muscles (Bartholow and Flint). 

PEMCULI. (See Lice). 

PEMPHIGUS. 

Is a skin disease characterized by an eruption of bullae. 
Bullae differ from vesicles only in their size. They resemble 
large blisters. Pemphigus is the typical bullous disease. 

Description. — This is a comparatively rare affection; it is 
more common in children than adults. It appears in very large 
vesicles or bullae, surrounded by a slight zone of erythematous 
redness. The blebs occur in crops and look like small blisters 
filled with serum. They are not met with on the scalp; where 
there are few bullae we generally find them on the ankle, or on 
the hand. The disorder may be acute or chronic. It occurs 
mostly in persons of feeble constitution. Relapses are frequent. 
Pemphigus may be produced by the administration of iodide of 
potassium, or by syphilis. 

Syphilitic Pemphigus. — Is mainly met with on the soles of 
the feet and the palms of the hands of the newly born syphilitic 
children. The bullae vary in size from that of a pea to a walnut 
(Anderson and DaCosta). 

Causes. — Are unknown. 

Treatment. — Tonics must be given, and of these the most 
important are quinine and arsenic. Local treatment is effective. 
The bullae, if tense, may be opened, and afterwards dusted with 
a soothing powder. Baths are highly recommended (Anderson). 



388 A COMPENDIUM OP PRACTICAL MEDICINE. 

PRESCRIPTIONS FOR PEMPHIGUS. 

R Sodii biboratis 5ss. 

Tragacanth 3j . 

Spiritus rectificati 31J . 

Glycerinse ^iv. 

Aqua? destillatse ^iss. — M. 

Sig. : Smear a little over the excoriated part and allow it to dry. 

— Anderson. 

R Pulveris lycopodii Jj. 

Sig. : Use as a dusting powder after the bullse are cut. Then 
use zinc ointment, and then use the following : 

R Argenti nitratis gr. iij.-iv. 

Adipis £j — M. 

Ft. ungt. 
Sig. : Apply locally. —Tilbury Fox. 

PERICARDITIS. 

Is an inflammation of the serous membrane (the pericard- 
ium) investing the heart. The inflammation may be circum- 
scribed or diffused, acute or chronic. 

Causes. — Primary pericarditis may arise from injuries to 
the pericardium, or from cold. Secondary pericarditis is more 
common, and is due to two causes: 1. To an extension of in- 
flammation from neighboring parts, as in pneumonia, left pleu- 
risy, pulmonary tuberculosis, caries of the sternum or ribs, aneu- 
rism of the aorta, endocarditis, etc. 2. To the rheumatic dyscra- 
sia. It also occurs in the course of Bright's disease, acute 
infectious diseases, as scarlet fever, smallpox, typhus and typhoid 
fever, and of syphilis and chronic alcoholismus. It is of most 
frequent occurrence in connection with acute articular rheuma- 
tism, Bright's disease and pneumonia (Bartholow and Loomis). 

Symptoms. — Pericarditis occurs most frequently between the 
ages of 15 and 30. The two prominent rational symptoms are 
]><iin in the precordial region, and palpitation. The pain may 
also involve the brachial plexus and extend down the left arm. 
It is sometimes very slight, again it is sharp and lancinating. 
With the pain there are palpitation, a dry irritable cough, and a 
sense of constriction over the whole chest, with more or less 



PEEICAEDITIS. 389 

dyspnoea. The cough is suppressed and forced breathing in- 
creases the pain. If there is much effusion the patient assumes 
the half sitting posture. The face is often livid and has the 
apjDearance of suffering and anxiety. At first the pulse is full 
and strong, and more or less accelerated. When there is much 
effusion it is irregular, intermitting, and strongly dicrotic. 
Pyrexia, anorexia, and debility are present. There may be 
jaundice, headache, and delirium. The pain and soreness 
usually diminish when the fluid eifusion takes place; and now 
the patient has a sensation of oppression in the cardiac region, 
with a tendency to syncope on moving. If there be much effusion 
it will cause dyspnoea, feebleness of the voice, or even aphonia 
and dysphagia. Cyanosis and turgescence of the cervical veins 
are sometimes marked, due probably to pressure on the auricles 
and the vense cavse. 

Singultus (hiccough) may be produced by pressure on the 
phrenic or branches of the pneumogastric nerve. As pericarditis 
is, in the great majority of cases, associated with acute articular 
rheumatism, Bright's disease, pleurisy or pneumonia, it is imper- 
ative to make a physical examination of the heart, when these 
diseases exist (Flint and Loomis). 

Physical Signs. — Are most important. They vary in the dif- 
ferent stages of the disease. In the first stage, inspection and 
palpation show an irritable, turbulent, forcible, and sometimes 
irregular action of the heart. Palpation gives a friction-Jremi- 
tus in a few cases for a brief period. This vibration of the chest 
wall is caused by the rubbing together of the roughened surfaces 
of the pericardium. To develop this sensation, firm pressure 
must be made in the intercostal space with the finger tips; as the 
whole hand laid on the chest may not detect it; it is a rouo;h, 
jarring, rasping sensation. On auscultation the first positive 
physical sign of pericarditis is the pericardial or cardiac -friction 
murmur which is produced by the rubbing together of the two 
surfaces roughened by exudations. This friction murmur makes 
the impression on the ear of scraping, grating, creaking and 
churning. This cardiac friction murmur will be increased in 
intensity when the body is bent forward, and also by a full in- 
spiration. It is superficial in character, and is double, one sound 



390 A COMPENDIUM OF PRACTICAL MEDICINE. 

is produced by the systolic and the other by the diastolic cardiac 
movements. The friction murmur and friction fremitus occur 
within the first two days, and may persist for several days. A 
friction murmur, if ever wanting in the first stage of pericarditis, 
is present so generally, that we are warranted in basing an ex- 
clusion of the disease on its absence. The murmur is almost 
pathognomonic taken in connection with the symptoms and his- 
tory. 

In the second or stage of effusion the friction murmur disap- 
pears after considerable effusion of liquid has taken place, but it 
may continue in this stage and also in the stage of convalescence. 
Inspection now shows diminished respiratory movements over 
the precordial space and an arching forward of the precordial 
region with abolition of the intercostal depressions. Palpation 
shows the apex-heat to be weakened, to be raised to the fourth 
intercostal space and to be carried to the left as far as, or even be- 
yond the line of the nipple. Percussion shows an increased area 
of dullness or flatness in the precordial region. The form of this 
dullness is triangular or pyramidal, with the base of the pyra- 
mid below and the apex near the sternal notch. Vocal resonance 
is diminished or absent within the area of dullness or ilatness, 
and also vocal fremitus. In most cases the iluid disappears rap- 
idly within a week or ten days. 

The third stage is the stage of absorption. As the effu- 
sion is absorbed, the friction murmur and fremitus reappear and 
the area of dullness lessens (Bartholow, Flint and Loomis). 

Differential Diagnosis. — Pericarditis may be confounded with 
endocarditis, hydropericardium, cardiac hypertrophy and left 
pleurisy. In pericarditis, the friction murmur is a sound of 
rasping or crackling and superficial in character, varying from 
one hour to another in intensity and increases with pressure of 
the stethoscope on the chest wall. It also increases in loudness 
with the upright position and bending forward. The friction 
murmur disappears when the effusion reaches a certain amount. 
There is an increase of percussion dullness. 

In endocarditis, the endocardial murmur is a soft, smooth, 
blowing sound, deep in character, remaining constant, is not 
affected by pressure of stethoscope on chest wall, and is most 



PERICARDITIS. 391 

\ 

distinct in the recumbent position. The endocardial murmur is 
permanent. There is no increase of yjercussion dullness. In 
pleurisy, the friction sound is synchronous with the respiration; 
in pericarditis it is synchronous with the cardiac movements; 
suspension of respiration arrests the former, but does not affect 
the latter. In pleurisy with effusion, all voice and breath sounds 
disappear; in pericarditis, they are unaffected. Hydropericard- 
ium is to be distinguished from pericarditis by the absence of 
fever, local pain and friction murmur. 

In hypertrophy of the heart, the action is heaving, there is 
an increase in the force of the apex- beat, and an abnormal in- 
tensity to the heart sounds; in pericarditis all these will be 
diminished in intensity. In hypertrophy of the right heart the 
precordial dullness never extends to the left beyond the apex 
beat, while in pericardial effusion it may extend one or two 
inches beyond the apex -beat. In hypertrophy or dilatation of 
the left heart, the apex-beat is carried downward and to the left, 
and the area of dullness is increased in the same direction and 
not to the right, as in pericarditis (Bartholow and Loomis). 

Prognosis. — Simple and rheumatic pericarditis are not often 
fatal. As an intercurrent disease, coming on in the course of 
scorbutis, pyaemia, puerperal diseases, Bright's disease, some of 
the eruptive fevers, pneumonia, etc., it is extremely fatal. A 
large amount of fluid may compress and cause paralysis of the 
heart. In rare instances a fatal syncope occurs (Bartholow and 
Loomis). 

Treatment. — Discover and remove the cause if possible. 
Absolute rest in bed must be enjoined. Opium is the most 
valuable internal agent for the pain and constitutional disturb- 
ance. As pericarditis is a disease of the weak and feeble, and 
the young, iron, stimulants, and a highly nutritious and readily 
digestible diet are the most efficient remedies (Loomis). In the 
first stage Bartholow recommends a full dose of quinine (gr. xx.) 
with half a grain of morphine. He would also give five grains 
of the carbonate of ammonia every two hours, when the exuda- 
tion is forming. The same authority would give infusion of 
digitalis in a tablespoonful dose every four hours. To promote 
absorption, the prsecordia may be painted with the tincture of 



392 A COMPENDIUM OF PEACTICAL MEDICINE. 

iodine daily. The operation of paracentesis is required when 
the effusion is great, or when it is purulent (Bartholow). 

PRESCRIPTIONS FOR PERICARDITIS. 

|& Antimonii et potassii tart gr. iv. 

Tinct. opii gj . 

Aquae camphorse ^viij. — M. 

Sig. : A tablespoonful every two hours. — Graves. 

Jfc Hydrargyri chloridi mitis 

Pulv. ipecac aa gr. vj. 

Potassii nitratis 3ss.-j. — M. 

In pulv. no. xii. div. 
Sig. : A powder every three hours. — Hartshorne. 

Jfc Tinct. aconiti radicis |ss. 

Sig. : Half a drop to a drop every quarter of an hour for two 
hours, then every hour or two. — Ringer. 

{& Empl cantharidis 2x3 inches. 

Sig.: Apply over the precordial space. Repeat at intervals after 
the skin is healed. (In chronic stage.) — Tanner. 

PERIOSTITIS. 

Is an inflammation of the periosteum. Endostitis is an 
inflammation of the endosteum. Ostitis is an inflammation of 
bone. Inflammation of these structures may be acute or chronic. 

Causes. — Acute inflammation of bone whether originating 
in the periosteum or endosteum is chiefly found during the 
growing period of bone, and is a very grave affection. It occurs 
in the feeble and cachectic, and in those termed scrofulous. It 
occurs in the shafts of the long bones as well as in the epiphysis, 
and in those most exposed, as the tibia and ulna. It is also seen 
in the femur. It is often the result of some local injury or ex- 
posure. In some cases there is no assignable cause (Bryant). 

Termination. — It may end in local abscess of bone, in diffused 
suppuration, or in the more or less complete death of the bone. 
The bone by the inflammation has been deprived of its vascular 
supply through a blocking of its capillaries, its death resulting 
from blood stasis (Bryant). 



PERIOSTITIS. 393 

Symptoms. — The disease is usually ushered in with a deep 
aching pain in the bone, with local tenderness, often a rigor, 
followed by intense constitutional disturbance and increase of 
temperature, and by swelling and immobility of the limb. If 
the origin of the disease is in the periosteum, the skin soon be- 
comes red; if in the endosteum, many days will pass before red- 
ness appears. When pus forms, the skin becomes inflamed, 
rigors become more frequent, pain is more intense, sleeplessness 
and delirium apj3ear, and unless relief be afforded by a free in- 
cision down to the bone, death by exhaustion, and probably by 
blood-poisoning is apt to occur (Bryant). 

Treatment. — In all cases of acute inflammation of bone or peri- 
osteum, there is no treatment equal to that of a free incision 
down to the bone. It is not necessary to wait for the formation 
of pus before making the incision. The object of the incision is 
to relieve tension and thereby relieve pain. The limbs should be 
elevated and hot fomentations applied. Pain should be relieved 
by morphine (Bryant). 

CHRONIC PERIOSTITIS AND OSTITIS. 

Are very common affections more particularly involving the 
shafts of the long bones. 

Causes. — These affections may be modified by syphilis, scrof- 
ula or rheumatism, and may originate from some local cause or 
injury (Bryant). 

Symptoms. — Are similar to, though less severe than those of 
the acute, the most constant being a dull, aching pain in the part 
of a persistent kind, aggravated at intervals and on hanging 
down the limb, the pain being almost always worse at night, 
more particularly in syphilitic affections (Bryant). 

Differential Diagnosis. — In periostitis the pain is local, with 
swelling early; tenderness on manipulation is an early and con- 
stant symptom; there is enlargement of bone with one or two or 
more nodes upon its surface, and when suppuration ia about to 
take place, increased swelling, tenderness and redness will be 
present. 

In endostitis the pain is diffused through the whole bone, 
and will continue for weeks and months without swelling: the 



394 A COMPENDIUM OF PRACTICAL MEDICINE. 

bone may be manipulated without pain, and enlargement of 
bone in all directions takes place (Bryant). 

Treatment. — When suppuration does not take place, fomen- 
tations, with the elevation of the limb, sedatives to allay pain, 
and the internal use of the iodide or bromide of potassium are 
the most efficient means. A blister or tincture of iodine may be 
useful. When pain is severe opium internally and belladonna 
externally give relief. When pus has formed make an incision 
(Bryant). 

PERITONITIS. 

Is an inflammation of the whole or a part of the serous mem- 
brane which lines the abdominal wall and covers the viscera 
contained in the abdominal cavity. It may be acute or chronic; 
local (circumscribed) or general (diffuse) ) primary or secondary 
(Loomis). 

Causes. — Peritonitis may occur at any age in the strong and 
robust as well as in the weak and feeble. As a primary disease 
it is rare. The exciting causes are: 1. Intestinal obstructions 
and perforations. Under this head may be included typhlitis 
and perityphlitis with ulceration; rupture of hepatic and other 
abscesses; ulceration and rupture of the stomach, gall and urinary 
bladder; rupture of hydatid and ovarian cysts; ulcerations and 
perforations of the intestines in typhoid fever, and syphilitic or 
tubercular intestinal ulcers. Injections into the uterus, rupture 
of an organ from a blow or fall, penetrating wounds of the ab- 
domen and necrosis of the spine, ribs or pelvic bones, are causes. 

2. Extension of inflammation as from the stomach or 
intestines, from the uterus and its appendages, liver, spleen and 
kidneys, from typhlitis, perityphlitis, proctitis and periprocti- 
tis, ulcer of the rectum, intussusception, volvulus and hernia of 
the intestine. 

3. Peritonitis is frequently an intercurrent malady coming 
on in the course of a certain cachexia, as pyaemia, septicaemia, 
puerperal fever, albuminuria, the eruptive fevers, erysipelas, 
long standing ascites, general tuberculosis and cancer, etc. Tu- 
bercular peritonitis is met with most frequently in early life, and 



PERITONITIS. 395 

cancerous peritonitis between the ages of 40 and 60. Exposure 
to cold and wet may cause it (Bartholow and Loomis). 

Symptoms. — If peritonitis is the result of intestinal perfora- 
tion, its onset will be marked by excessive pain over the whole 
abdomen. In infectious peritonitis, the first symptom will be a 
severe chill. Peritonitis resulting from an extension of inflam- 
mation, begins with local and gradually increasing pain. All 
varieties of acute peritonitis are ushered in by pain as one of the 
earliest symptoms. The pain may be local or diffuse, and is de- 
scribed as a cutting, burning pain, aggravated by pressure and 
movements of the abdomen. The pain causes the patient to 
remain motionless on his back, with the knees drawn up, the res- 
pirations are rapid and superficial, and the face, by its pallid, 
drawn and anxious look is almost diagnostic of the disease. In 
general peritonitis the abdomen soon becomes distended and 
tympanitic. At first the abdominal muscles are rigid and con- 
tracted, but soon relax. The temperature, in most cases, ranges 
from 102° to 103° F. In fatal cases it may fall below the normal 
during the period of collapse. 

The pulse is accelerated, often reaching 140 per minute. It 
is small, hard and wiry in character. For hours before a fatal 
issue it may beat 200 per minute. Vomiting is a prominent 
symptom, and at first articles of food and gastric mucus come up 
then biliary matters from the duodenum. Whenever stercorace- 
ous vomiting occurs in peritonitis, it is evidence of intestinal ob- 
struction. 

The tongue is coated and the appetite impaired at the onset. 
Constipation is the rule in peritonitis. It is due to paresis of the 
bowel. The urine is scanty, and then there may be retention or 
strangury, if the inflammation extends to the bladder. In acute 
peritonitis there is a tendency to heart failure and collapse. In 
all varieties disease rarely runs a typical course; even pain 
may be absent. When peritonitis follows intestinal perforation, 
all the symptoms from the onset are severe. The face quickly 
becomes haggard, drawn and dejected; the eves are sunken and 
surrounded by dark purple rings; the nose and cheeks are 
pinched, the lips are blue, the voice feeble, the extremities cold 
and covered with sweat, the pulse very weak, kk Cheyne- Stokes" 



396 A COMPENDIUM OF PRACTICAL MEDICINE. 

respiration and death is within 48 honrs. The mind is usually 
clear throughout the entire course of the disease: but in infect- 
ious peritonitis loss of consciousness, apathy, or delirium may 
precede death by a few hours. In cases of much effusion the 
pain subsides. In suppurative peritonitis the pain is frequently 
absent, but typhoid symptoms are present from the onset, delir- 
ium and rigors are common, and the pulse becomes very rapid. 
Occasionally, when perforation of the bowel or stomach takes 
place, the patient has the feeling as if something had suddenly 
burst or been torn within the abdomen. 

Local or Circumscribed Peritonitis. — Usually pursues a 
sub -acute rather than an acute course. Chronic peritonitis 
(non- tubercular and non- cancerous) is usually the sequel of an 
acute attack. If an acute attack does not subside in one week, 
it becomes chronic and there is a gradual increase in the size of 
the abdomen, with rigors and sweats. There is rapid loss of 
flesh and strength. The face is haggard and drawn. The pain 
assumes a colicky character and is a "dull ache.' 7 The pulse is 
small and rapid. There is anorexia with vomiting. The tem- 
perature is 99° to 104° F. 

Tubercular Peritonitis. — In tubercular peritonitis the pain 
is paroxysmal in character. It often occurs suddenly with rapid 
and feeble pulse, fever, nausea, vomiting and diarrhoea. The 
tongue is coated. The skin is harsh and dry. There is great 
thirst and rapid loss of flesh and strength. Typhoid symptoms 
come on early. Effusion into the peritoneal cavity takes place 
and the patient dies of asthenia. Redness and oedema about the 
umbilicus are regarded as characteristic of tubercular peritonitis. 
Hectic fever is accompanied by profuse sweats during sleep, and 
the abdomen has a doughy feel. The pain may be so slight as 
to amount only to a sense of tension and fullness in the abdo- 
men. Some cases are unattended by ascities, and knots of intes- 
tine embedded in firm hard masses are felt in the region of the 
umbilicus. Friction sounds may be heard over these masses. 
Tubercular peritonitis may have for its chief and only symptoms 
ascites, anaemia, and the evidences of general tuberculosis. Occa- 
sionally its progress is interrupted, and there is marked improve- 
ment and cessation of all the abdominal symptoms, and then 



PERITONITIS. 397 

there follows a period when death seems imminent. The mesen- 
teric glands are usually enlarged. 

Cancerous Peritonitis. — Is attended by the same local 
symptoms as tubercular. Sometimes a tumor may be felt, espe- 
cially in the region of the omentum and mesentary. There is 
always ascites; the fluid collects gradually, and often in very 
large quantities. In some cases the abdomen is very sensitive, 
and paroxysms of colicky pains are frequent. The temperature 
rarely reaches 100° F. The diagnosis rests on the presence of a 
gradually increasing tumor and the cancerous cachexia (Bar- 
tholow and Loomis). 

Differential Diagnosis. — Peritonitis may be confounded with 
intestinal colic, intestinal obstruction, enteritis, abdominal neu- 
ralgia, hysteria, rheumatism of the abdominal muscles, renal and 
biliary colics, and suppurative cellulitis of the abdominal walls. 
The ascites of chronic peritonitis may be mistaken for that of 
the last stages of cirrhosis of the liver. Gastric symptoms are 
prominent in cirrhosis and absent in peritonitis. The counte- 
nance has a clay- colored or jaundiced hue in cirrhosis; in peri- 
tonitis it is pale and anxious. The liver is diminished and the 
spleen increased in size in cirrhosis. The abdomen is excess- 
ively tender in chronic peritonitis, and the fluid accumulates 
more rapidly than in cirrhosis. In peritonitis there is usually a 
distinct febrile movement, the pulse is accelerated and is tense 
and wiry in character. In colic there is no fever or increase in 
pulse-rate, the rule being rather a slowed pulse. In peritonitis 
the patient avoids the slightest motion of the body, and firm 
pressure over the abdomen increases the pain, while in colic the 
patient tosses from one side to the other, and firm pressure over 
the abdomen relieves the pain. The pain of peritonitis is con- 
stant, that of colic paroxysmal. 

Intestinal obstruction, if it begins with colicky pains, is 
soon attended by faecal vomiting, the pain is localized, there is a 
subnormal temperature and more distention of the abdomen; 
while peritonitis is attended by fever, by great tenderness on 
pressure, by a tense, hard, wiry pulse, and by rigidity of flu 1 
abdominal walls. Peritonitis conies on rapidly, and at Its onset 
the abdomen becomes exceedingly tympanatic and tender to 



398 A COMPENDIUM OF PRACTICAL MEDICINE. 

pressure, while enteritis comes on slowly and excessive tympanites 
is rare. In enteritis the vomiting is severe; in peritonitis rare. 
There is constipation in peritonitis, while diarrhoea is the rule in 
enteritis. The pulse is tense and wiry in peritonitis, rapid and 
feeble in enteritis. The fever is higher in enteritis. The symp- 
toms of collapse, the anxious face, superficial respiration, and 
immobility of the patient are characteristic of peritonitis. 

In abdominal neuralgia, the pain simulates that produced 
by a tightly drawn cord about the abdomen, and follows the 
course of the genito- crural nerve. There is tenderness on pres- 
sure only at the point of exit of the nerve from the spine. The 
tympanites, the ascites, the fever, the rapid pulse, the signs of 
collapse, and the muscular rigidity of peritonitis are all absent 
in neuralgia. In hysteria the firmest pressure does not increase 
the pain if the attention of the patient is engaged. 

The rapid pulse, fever, signs of collapse, and anxious face of 
peritonitis are. absent, and there is present the globus hystericus, 
and the attack is followed by the passage of a large quantity of 
watery, straw-colored urine. In rheumatism of the abdominal 
muscles, the pain and tenderness are most intense at the origin 
and insertion of the muscles. There is no fever, no vomiting, 
and no signs of collapse. The pulse is normal. There is a his- 
tory of rheumatism. In biliary colic the patient throws himself 
about in excruciating agony, and the pain is referred to the re- 
gion of the common bile-duct, is paroxysmal in character, and 
will shoot back from the margin of the ribs over the gall-blad- 
der to the spinal column. If it continues 24 hours the patient 
becomes jaundiced. In renal colic, the pain radiates from the 
kidney along the ureter to the testicle which is retracted. In 
both these colics there is no fever, no rapid pulse and no tymp- 
anites or tenderness on firm pressure. In suppurative cellulitis, 
of the abdominal walls, the superficial swelling and the absence 
of constitutional symptoms of peritonitis establish the diagnosis 
(Bartholow, Flint and Loomis). 

Prognosis. — Acute general peritonitis is always a grave dis- 
ease. Its average duration is from four to eight days. The 
usual termination is in death. When it arises from perforation, 
a fatal result may occur in two or three days. The gravest cases 



PERITONITIS. 399 

are those which occur in the course of septic diseases. General 
puerperal peritonitis is almost always fatal. Peritonitis from 
rupture of an organ is always fatal. The prognosis is favorable 
when the peritonitis is clue to extension of inflammation from a 
viscus. Tubercular peritonitis, after weeks and months of anae- 
mia and exhaustion, terminates in death. The same may be said 
of carcinomatous peritonitis (Bartholow and Loomis). 

Treatment. — In the strong and robust at the very onset of 
the attack, ten to twenty leeches may be applied over the abdo- 
men. While acute peritonitis is progressing the bowels cannot 
be moved, and no benefit would result if they were, so that under 
no circumstances should there be an attempt at purgation. The 
opium plan of treatment first developed and brought to the 
notice of the profession by Prof. Alonzo Clark, is the most effi- 
cacious. With the first symptoms of peritonitis, give at one dose 
from two to iive grains of opium, or one -half to one grain of 
morphine every two, four, six or eight hours according to the 
effect. The rule is to bring the patient as soon as possible fully 
under the influence of the drug, and maintain a moderate degree 
of narcotism, not until all pain and tenderness have subsided, 
but until the pulse has reached its normal standard and tympan- 
ites has entirely subsided. When the patient is fully under the 
influence of the opiate, the entire surface of the body becomes 
bathed in a profuse perspiration. In 24 hours a rash, due to the 
opium, will make its appearance with an itching of the surface 
and nose. The pupils become contracted, the eyes suffused, the 
countenance assumes a dull expression, there is a constant desire 
to sleep, the pulse becomes less rapid, and the respirations may 
be only twelve in a minute. Now the patient is in the condition 
in which it is desirable to keep him, and with the respirations 
at twelve per minute he is perfectly safe. If it is found 
difficult to arouse the patient, the administration of opium 
must be stopped until he can be easily aroused. When 
the pulse becomes less frequent and the tympanites subsides, 
one may be certain that he is controlling the peritonitis. 
By this plan of treatment an acute peritonitis may be con- 
trolled within 48 hours from its onset; but the treatment 
must be continued four or five days longer for fear of relapse. 



400 A COMPENDIUM OF PRACTICAL MEDICINE. 

Wait at least a week before giving a cathartic (castor -oil). The 
local applications should consist of warm fomentations, mustard 
plasters, or tincture of iodine. At the beginning large doses of 
quinine are in a high degree beneficial. The vital powers must 
be kept up by suitable nutrients and stimulants. Ice may be 
given to relieve the thirst. If hiccough is distressing, it should 
be relieved temporarily by the inhalation of chloroform. Vomit- 
ing is sometimes allayed by carbonated water, ice and champagne, 
or hydrocyanic acid. Turpentine, as an injection and employed 
locally will sometimes relieve the tympanites. Bartholow be- 
lieves that ten grains of the carbonate of ammonium in an ounce 
of the solution of the acetate, every four hours, when the exuda- 
tion is going on, is a remedy of the highest utility. In the 
peritonitis from perforation absolute repose, opium, ice, and the 
avoidance of all foods and drinks, are the proper measures. In 
puerperal peritonitis, great attention should be paid to the uterus. 
In chronic peritonitis, iodide of potassium should be given in- 
ternally, and iodine and mercury should be applied locally. The 
effusion may be removed by tapping. In tubercular peritonitis, 
small doses of opium, with tonics and cod- liver oil, may be 
given, and warm anodyne applications to the abdomen. In can- 
cerous peritonitis, the treatment is symptomatic (Bartholow, 
Flint and Loomis). 

PERTUSSIS. 

Called also whooping-cough, is an acute contagious disease, 
occurring chiefly in childhood, and once only during life; it is 
characterized by successive forcible expirations, and at their 
termination by a loud, resounding, sonorous inspiration (Bar- 
tholow). 

Causes. — A large majority of the cases occur between the 
ages of one and ten years. The special exciting cause of this 
disease is a contagious principle which acts upon the respiratory 
organs. The specific poison is given off in the breath of the af- 
fected and conveyed through the air, or in clothes to the healthy. 
It affects all races and classes and is more prevalent in winter 
and spring. It may occur as an epidemic. The period of incu- 



PERTUSSIS. 401 

bation varies from five clays to two weeks (Smith and Bartho- 
low). 

Symptoms. — There are three stages of this disease; first, that 
of catarrh of the air -passages; second, the stage of spasmodic 
cough; third, the stage of decline. The first stage is character- 
ized by the symptoms of coryza and bronchitis. The eyes may 
be suffused, there is sneezing, cough begins, and there may be 
fever, thiist and impaired appetite. The duration of the first 
stage varies from eight to fifteen days. The spasmodic stage is 
characterized by the spasmodic cough. The cough consists of a 
succession of short, rapid expiratory efforts; the face gets red; 
the eyes swell and protrude and the body is bent forward in 
coughing, then when the breath is entirely exhausted, a deep, 
loud, crowing inspiration occurs. During each paroxysm there 
may be two, three or more of such efforts, and at the expiration 
of them the patient brings up a quantity of tenacious, glary mu- 
cus, and is often accompanied by vomiting. The duration of the 
paroxysms varies from a few seconds to several minutes, and the 
number of them daily, varies from ten to a hundred. They are 
most frequent at night. The duration of the second stage is from 
30 to 60 days. The third stage or stage of decline is short, not con- 
tinuing longer than two or three weeks (Smith and Bartholow). 

Complications. — The cerebral complications consist in con- 
vulsions, hydrocephalus, and cerebral congestion. The lung 
complications are pulmonary congestion, bronchitis, pneumonia 
and emphysema. Capillary bronchitis and pneumonia are always 
serious complications (Smith, J. L.). 

Prognosis. — Whooping-cough is always a serious disease, 
although it is rarely directly fatal; yet indirectly it frequently 
causes death (Loomis). 

Treatment. — Is symptomatic. Alum is recommended by 

Golding Bird (gr. iv. every four hours), and Meigs says it is the 

best remedy. In the catarrhal stage the following formula of 

Bartholow may be used : 

j& Syrupi scill'ae comp 3j. 

Tinct. aconiti rad lllxvj. 

Tinct. opii deodorat HIviij. 

Syrupi tolu svij. 

Aqua? lauro-cearsi .sj . — M. 

Sig. : A teaspoonful every two, three or four hours. 



402 A COMPENDIUM OF PRACTICAL MEDICINE. 

Tincture of aconite, tincture of belladonna, deodorized tinc- 
ture of opium and fluid extract of ipecac in suitable proportions 
according to age, is a most serviceable combination. If the 
child is old enough a gargle of bromide of potassium may be 
used with advantage. 

Bartholow would give, in the spasmodic stage, opium, in the 
form of codeine, which can be employed with proper precautions^ 
even in the case of infants. A slight hypnotic effect should be 
maintained constantly. The mono -bromide of camphor in from 
two to ten grains every four hours seems to be most beneficial. 
The very best results, and often an immediate arrest of the dis- 
ease, can be procured by full doses of quinine. Dilute hydro- 
cyanic acid and nitric acid well diluted are useful remedies. 
Good results are obtained by inhalation of carbolic spray in 
many cases. A one per cent, solution is strong enough for this 
purpose. Sonnenberger regards antipyrine as a specific in doses 
of one and a half grains three times daily for a child one year old. 
Peroxide of hydrogen has been used as a spray to the fauces with 
some success. Whooping-cough is a self -limited disease and 
must be treated expectantly. The patient, by warm clothing, 
should guard against undue exposure (Smith, Bartholow and 
Loomis). 

PHAGEDENA, 

Is molecular gangrene, or rapid ulceration. This variety of 
ulcer spreads with great rapidity, destroying everything within 
its reach. 

Causes. — Are general and local. Bad hygiene, misery, diges- 
tive troubles, scrofula, scorbutus, malaria, chronic alcoholism and 
old age are prominent general causes. It is frequently met with 
in persons broken down with disease, or who are much debili- 
tated. The local causes are: lack of cleanliness, phimosis from 
retention of pus, and all sorts of local irritation. Phagedena r 
most commonly found with chancroid, is not confined to this 
variety of sore. Syphilitic chancre is sometimes phagedenic; 
different ulcerated syphilides and scrofulides occasionally become 
phagedenic. 



PHAGEDENA. 403 

Phagedena attacks virulent bubo perhaps as often as it does 
chancroid. Phagedena is not a property belonging to chancroid 
pus, it is rather a property of the tissues of the patient. Hence 
the conclusion is, that there is no special phagedenic virus. ~No 
definite duration can be assigned to phagedena. The bottom of 
a phagedenic ulcer is liable to be covered with a slough which is 
of a grayish color. The discharge is serious, profuse, and highly 
offensive (Keyes). Phagedenic sores are rarely seen except in 
connection with syphilis or hospital gangrene. In syphilis 
sloughing is found in the intemperate and ill -fed, and mostly in 
gin -drinking prostitutes (Bryant). 

Treatment.— Cleanse the part by soaking up with absorbent 
cotton all the discharges from the ulcer that may be present; 
then destroy the edges of the ulcer with some one of the acids. 
When this has been done, touch the edges of the sore with ab- 
sorbent cotton saturated with nitrate of mercury one part, water 
eight parts, and insert the cotton under the undermined edges of 
the sore. Having done this, sprinkle the edges with iodoform. 
Surrounding the slough is an acutely inflamed surface; paint this 
with the tincture of iodine and dress the limb with a solution of 
acetate of lead and laudanum, keeping the parts in an elevated 
and relaxed position. Give the patient nourishing diet, quiniue 
and iron, and stimulants if necessary, If the pain is severe give 
one grain of opium every eight hours (Horwitz). 

PHARYNGITIS. 

Is an inflammation of the mucous membrane of the tonsils 
uvula, soft palate, and pharynx. It may be acute or chronic 
(Loomis). 

Causes. — The most prolific cause is taking cold. Next to 
this is the use of cigarettes, and then comes alcoholic excess. 
Diphtheria, the eruptive fevers, and inflammatory affections of 
the air passages are accompanied by this disease. Acute pharyn- 
gitis is one of the forms of ''ordinary sore throat. 11 It occurs 
most frequently in children and in young adults. One attack 
predisposes to others. Chronic follicular pharyngitis may be 
produced by prolonged use of the voice in public speaking or 



404 A COMPENDIUM OF PRACTICAL MEDICINE. 

singing. Weak, scrofulous persons are affected with it. It is 
sometimes called clergyman 's sore throat (Bartholow and 
Loomis). 

Symptoms. — In acute cases, there is at first an unpleasant, 
stuffy and dry feeling in the naso- pharyngeal space, followed 
later by secretion. There may be severe headache and pains in 
the upper jaw. Breathing through the nose is difficult. The 
voice is thick and nasal. An acute attack subsides in a few 
days. In the chronic form, the posterior nares are more or less 
obstructed by the swelling of the mucous membrane. Pain in 
the ear may be felt, and dullness of hearing is a common symp- 
tom from obstruction of the Eustachian tube. The mucus in the 
pharynx excites frequent attempts to swallow, and patients often 
"clear the throat" before speaking (Bartholow). 

Treatment. — In acute pharyngitis, ice cold carbonated water 
affords the greatest relief during the first twenty -four hours. The 
throat and mouth should be frequently sprayed with a solution 
of alum, tannin or sulphate of zinc, and at the same time the wet 
pack should be applied to the throat either hot or cold. The 
naso -pharyngeal cavity may be washed out with a solution of 
common salt or carbonate of sodium. Of the gaseous remedies 
none is so curative as ethyl-iodide which can be inhaled without 
apparatus. It can be vaporized at 100° F., and the simplest in- 
haler used. The vapor may be inhaled once daily through the 
nose for sometime. As a topical remedy a mixture of tannin and 
iodoform in finely divided powders, administered by insufflation 
is very effective (Bartholow and Loomis). 

PHLEGMASIA ALBA DOLENS. 

Called also "milk-leg,'' is a swelling of one or both lower 
extremities, occurring usually between the tenth and twentieth 
day after confinement, and characterized by pain, tension of the 
skin, and a milk-like whiteness of the surface. Owing to its 
color and its supposed origin, it has received the popular name 
of milk- leg (Lusk). 

Causes. — Phlegmasia is an affection of the connective tissue, 
and is associated in most, but not in all, cases with thrombosis 



PHLEGMASIA ALBA DOLEXS. 405 

of the veins. In a certain proportion of cases phlegmasia is 
obviously the extension of an inflammation from the genital 
organs to the perineum, the nates, and the upper portion of the 
thio'li. \Vhen the morbid changes follow the sheaths of the 
vessels, the walls of both veins and lymphatics thicken, and in 
most cases secondary thrombus formation results. A slowing of 
the blood current, and varicose veins, predispose to thrombosis. 
The crural and its branches, the tibial and peroneal veins are the 
ones usually involved. The intra- venous coao-ula may start from 
the placental site, and thus obstruct the veins. Thrombus form- 
ation may begin during pregnancy, and is then usually attended 
with pain at the seat of trouble, and with stiffness in the toes or 
the dorsnm of the foot (Lnsk). 

Symptoms, — Often phlegmasia is preceded by gastric dis- 
turbances, as lack of appetite, a furred tongue, constipation and 
chilly sensations. Sometimes the inflamed or thrombosed veins 
may be seen in the popliteal space or upon the inner surface of 
the upper portion of the thigh. The first characteristic symptom 
is a dull, dragging pain in the limb, which is increased by 
motion. There may be fever. In primary thrombosis the 
swelling usually begins at the ankle, and extends rapidly upward; 
in secondary thrombosis, the swelling begins at the inguinal fold 
and extends to the ankle (Lusk). 

Termination. — The ordinary termination of phlegmasia is by 
absorption of the thrombus. The period of extreme tension of 
the skin lasts for from five to eight days, and then recovery takes 
place slowly requiring three to six weeks. In a few cases, the 
thrombus may organize and permanently occlude the vessel. In 
rare instances the process may terminate in suppuration and 
abscess formation (Lusk). 

Treatment. — Opium must be given to alleviate the pain, 
cathartics to unload the bowels, quinine, iron and good food to 
sustain the strength, and rest for the swollen extremity. The 
limb should be elevated. Absorption should be promoted by 
gentle friction with alcoholic lotions, and by bandaging the entire 
limb evenly with a flannel roller. The patient should under no 
circumstances be allowed to leave her bed until well ( Lusk). 



406 A COMPENDIUM OF PRACTICAL MEDICINE. 

PHTHISIS. 

General Considerations. — Is derived from a Greek word which 
means to pass or waste away. It was formerly applied to all 
wasting diseases, irrespective of their causes. At the present 
day the term tuberculosis is supplanting the word phthisis, and 
very properly too, since the former expresses more accurately 
the condition than the latter. By the term tuberculosis, we mean 
a diseased condition caused by the introduction into the body of 
the tubercle bacilli. Specific nodules develop, which invade one 
organ or the entire system. Tuberculosis may be local or general. 
It is local when limited to one organ, as the lungs, kidney, liver 
or peritoneum. It is general when large numbers of tubercle 
bacilli enter the blood current and develop in the various organs 
of the body a multitude of miliary tubercles, called acute miliary 
tuberculosis. The tubercle bacilli and their spores travel in the 
blood current and wherever they lodge, a tubercle is developed. 
The tubercle therefore, is the result of an inflammatory process, 
and the infection which excites the inflammation is a specific 
vegetable parasite, called the tubercle bacillis, which gains en- 
trance into the body through the respiratory and digestive tract. 
We finally conclude that tuberculosis is an infectious disease and 
that its cause is the tubercle bacillus (Loomis and Flint). 

Tubercle. — Wherever the bacillus lodges and finds conditions 
suitable for its development and multiplication, there are found 
in a short time small, gray, translucent nodules, looking like 
particles of coarse sand, which are called miliary tubercles. 
Tubercles are non- vascular structures, no vessels have ever been 
found in them. They undergo caseous or cheesy degeneration. 
As they are non -vascular, their centres are shut off from nutri- 
tion, and as they are subjected to the necrotic action of the tu- 
bercle bacilli, in a short time they die and undergo what is 
called "coagulation necrosis." A small abscess is thus formed, 
and the union of several of these small abscesses form cavities. 
Instead of the course just described, these cheesy masses may 
become encapsulated, calcified, and remain as inert masses for 
an indefinite period. Again, the tubercle may undergo fibroid 
changes, the tissues surrounding the tubercle taking on a chronic 



PHTHISIS. 407 

fibroid inflammation, the newly formed connective tissue con- 
tracts, and compressing the tubercle, converts it into a fibrous 
nodule. This change is most likely to occur in the aged, and in 
those of a strong fibrous diatheses (Loomis). 

Questions. — The following questions have been asked and 
answered by Prof. Loomis : 

1. " Can man become infected with tubercle by eating tu- 
bercular meat, or by drinking the milk of tubercular cows V 

2. "May not the tubercle bacilli contained in the sputum 
and other discharges from tubercular subjects be infecting 
agents, and thus render tuberculosis a contagious disease V 

3. "As the tubercle bacilli preserve their vitality for along 
time outside the body, may not those contained in the sputum of 
tubercular subjects, after the sputum becomes dried and pulver- 
ized, be inhaled with the air as dust particles, and set up tuber- 
cular 23rocesses in the respiratory organs of non-tubercular 
subjects V 

4. " As a preventative measure for the spread of phthisis, 
should not the sputum and other discharges be burned or disin- 
fected in their fresh state V 

Answers. — "Accepting the doctrine that the tubercle bacillus 
is the only cause of tuberculosis, Ave are compelled to answer 
these questions affirmatively, and to say that the doctrine of 
heredity of tuberculosis must be abandoned, the tubercular taint 
being nothing more than a hereditary enfeeblement, which furn- 
ishes a better soil for the lodgment and development of the 
tubercle bacilli, or a physical condition which is less able to 
resist their invasion. 

The terms phthisis, pulmonary phthisis, phthisis pulmonalis, 
pulmonary consumption, and pulmonary tuberculosis are used 
interchangeably. 

Forms of Phthisis. — Bartholow gives four forms of phthisis: 
1. The phthisis of caseous pneumonia. 2. Tubercular phthisis. 
3. Fibroid phthisis. 4. Acute miliary tuberculosis, or general 
tuberculosis. Loomis gives two distinct varieties of pulmonary 
tuberculosis: 1. The acute. 2. The chronic. He further di- 
vides the chronic into the following: 1. Pneumonic tuberculosis, 
caseous pneumonia, or catarrhal phthisis. 2. Disseminated 



408 A COMPENDIUM OF PRACTICAL MEDICINE. 

tuberculosis. 3. Fibrous tuberculosis, or fibroid phthisis. He 
also discusses acute miliary tuberculosis. 

As respects the essential nature of this disease, there is no 
difference, all these forms being characterized by the presence 
and development of the bacillus tuberculosis. 

I. The Phthisis of Caseous Pneumonia. — Caseous phthisis 
is that form of pulmonary consumption characterized by the 
caseation or cheesy degeneration of inflammatory products in the 
lungs, and the subsequent softening and extrusion of the caseous 
matter with greater or less destruction of the pulmonary tissue. 

II. Tubercular Phthisis. — Is that form of pulmonary con- 
sumption characterized by the deposit of gray tubercle; by the 
changes due to such deposit, its softening and extrusion, and 
by the greater or less destruction of the proper tissue of the 
lungs. 

III. Fibroid Phthisis. — Is a form of consumption charac- 
terized by hyperplasia of the connective tissue of the lung and 
atrophy and degeneration of its proper structure, with, finally, 
tubercular deposits. 

IV. Acute Miliary Tuberculosis. — Is characterized by the 
presence of miliary tubercles in most of the organs of the body 
(Bartholow). 

Pathological Anatomy. — In most cases of pulmonary phthisis 
all of the structures which compose the lungs are the seat of 
morbid changes. There are lesions of the bronchi, of the alve- 
olar passages and air-cells, of the blood-vessels, of the lymphatic 
vessels, of the interstitial connective tissue, and of the plura. 
The characteristic lesions of phthisis are tubercles and inflam- 
matory processes with a tendency to caseous degeneration. 
Another morbid change of great importance is the formation 
of cavities. The morbid appearances are so manifold that it 
may be said that no two cases of phthisis are exactly alike. The 
dominating element in the pathological anatomy of pulmonary 
phthisis is tubercle. Tuberculous nodules or granules may be 
seen with the naked eye, and when young are gray or translu- 
cent, but oftener they appear opaque and yellowish, having 
undergone partial or complete caseous degeneration. , They 



PHTHISIS. 409 

vary in size from a millet- seed to a pea, and are often larger. 

A favorite and early situation for the formation of miliary 
tubercles is in the walls of the small bronchi or bronchioles. 
Many tubercles are composed of groups of air-cells filled with 
epithelial and lymphoid cells with or without giant cells. In 
the majority of cases tubercles are formed primarily at the apex 
of the lung. In acute miliary tuberculosis miliary tubercles are 
found scattered throughout both lungs. In these cases the tuber- 
cle bacilli are conveyed to the lungs by the blood- current. The 
usual mode of access of the tubercle bacilli to the lungs is by the 
respiratory passages. The production of cheesy pneumonia is an 
effect of the tubercle bacilli. In rare instances caseous pneu- 
monia involves a whole lobe or a whole lung (phthisis florida). 
In most cases of rapid or the so-called galloping phthisis 
(phthisis florida) more or less extensive patches of caseous pneu- 
monia form the greater part of the lesions. 

Tubercles are non- vascular structures and the pre-existing 
vessels, where the tubercles devolop, become obliterated, partly 
by thrombosis and partly by an accumulation of epitheloid and 
lymphoid cells in their lumen. The mucous membrane of the 
bronchi is always inflamed in phthisis, and contains tubercles. 
Ulcers usually of tuberculous origin are frequent. Some form 
of peribronchitis is a constant attendant of phthisis. Inflam- 
mation of the interstitial tissue of the lung, leading to 
the formation of new connective tissue, is called fibroid 
phthisis. In this case the affected lung is diminished in size. 

Pulmonary phthisis is always accompanied by pleuritis, 
usually of the dry form. The pleuritis leads to the formation of 
vascular adhesions. Of the non-inflammatory changes^ there are 
pigmentation with coal particles; calcification of caseous mate- 
rial; and localized and general oedema. After a variable period 
cavities are formed in the majoritv of cases of phthisis. They 
are of two kinds — those due to dilatation of the bronchi, bron- 
chiectases, and those resulting from the softening of cheesy 
material and its removal through the bronchi — ulcerative ca ci- 
ties. The greater part of a lobe, usually the upper lobe, may be 
converted into a single cavity. The cavities are, as a rule, irreg- 



410 A COMPENDIUM OF PRACTICAL MEDICINE. 

ular in form, and are often traversed by bands of fibrous tissue 
containing blood-vessels, the rupture of which maybe the source 
of dangerous hemorrhage. In cases of fatal haemoptysis the 
source of the hemorrhage is usually to be found in an aneurism 
about the size of a pea, which projects from the side of the artery 
into the cavity. As the expectoration contains tubercle bacilli, 
it is common to find tuberculous lesions in the respiratory tract 
above the lungs, especially in the larger bronchi, the trachea 
and the larynx. These lesions are usually in the form of tuber- 
culous ulcers, and are in nearly all cases secondary to the pul- 
monary affection. By swallowing sputum which contains the 
tubercle bacilli, the tuberculous virus may gain access to the 
intestinal tract and cause tuberculous ulceration which is most 
frequently in the lower part of the ileum. From the intes- 
tine the bacilli may be readily conveyed to the peritoneum, the 
mesenteric glands, the liver, etc. In most cases of pulmonary 
phthisis the primary infection takes place by inhalation of the 
tubercle bacilli in the apex of the lung. The bacilli are incapa- 
ble of development at a temperature below 82.4° F. and above 
107.6° F., the most favorable temperature for their growth being 
about that of the human body (Flint and Bartholow). 

Causes. — The proof that the tubercle bacillus is the specific 
cause of tuberculosis may be considered complete. This bacillus 
was discovered by Prof. Koch in 1882. The disease is never 
produced without this parasite, but the eificiency of this agent 
depends on the predisposition or diathesis. The latter alone is 
incapable of producing the disease. If the introduction of the 
parasite into the air passages could be prevented, the disease 
would not be produced, no matter how strong the predisposition; 
and on the other hand, if the predisposition be wanting, the dis- 
ease will not be produced, no matter how great the exposure to 
the specific cause. When it is considered that about one-seventh 
of all human beings die of phthisis, it is not difficult to account 
for the wide distribution of the tuburculous virus. The bacillus 
tuberculosis is not capable of multiplication outside of the ani- 
mal body, and hence pulmonary phthisis is not only an infecti- 
ous, but a contagious disease. The most fruitful source of 
tuberculous infection is to be found in dried phthisical sputum. 



PHTHISIS. 411 

That it may come from the milk of tuberculous cows is certain. 
Facts show the tuberculous predisposition or diathesis in a cer- 
tain proportion of cases to be congenital and inherited. The 
predisposition has a relation to age. The disease is most liable 
to be developed between 20 and 30; then 30 and 40, 10 and 20, 
40 and 50, 50 and 60, birth and 10, 60 and 70, 70 and 80, 80 and 
90, 90 and 100. Xo age is exempt from a liability to the disease, 
and it may affect the foetus in utero. Climate appears to exert 
an influence either for or against the development of the disease. 
The j)revalence of the disease is less in climates either uniformly 
warm and dry or uniformly cold and dry than in those which 
are moist and subject to frequent alterations of cold and warmth. 
It is rare in the torrid and frigid zones, and frequent in the tem- 
perate. According to Dr. Hialtelin, who resides in Iceland, the 
inhabitants of that country enjoy exemption from phthisis. 

A high altitude seems to afford protection against the dis- 
ease. In Alpine situations elevated 4000 feet, tuberculosis is 
almost unknown. The condition of the soil of a region favors 
or is antagonistic to phthisis, light, sandy, porous soils are antag- 
onistic; while heavy wet, hard, clayey, impermeable soil, and 
sudden changes in the temperature are the most favorable con- 
ditions for developing phthisis. Want of sunlight, defective 
ventilation, lack of exercise, and the depressing emotions act as 
strong predisposing causes. As regards season, the disease is 
oftener developed during the spring months and the hot months 
of summer than at other seasons of the year. Tuberculosis may 
be communicated by the use of dishes, napkins, handkerchiefs. 
and other personal belongings of phthisical subjects; by the use 
of milk of tuberculous women, and possibly by tuberculous meat. 
The scrofulous or strumous constitution may constitute the 
tubercular diathesis; but according to Loomis, phthisis may de- 
velop without this vice of constitution. Mothers transmit phthis- 
ical tendencies more certainly than fathers. But when one 
parent alone is affected, the mother is more apt to transmit to 
the daughters than to the sons, and vice versa. A phthisical vice 
of constitution may be inherited by the children of the aged, of 
drunkards, of those enervated by excesses, and of those who at 
the time of the birth of their children were suffering from some 



412 A COMPENDIUM OF PRACTICAL MEDICINE. 

form of constitutional disease, such as cancer, syphilis, or gout. 
Children of consanguineous marriages are especially liable to 
pulmonary phthisis. 

Improper and insufficient food is an influential cause of tu- 
berculosis. The repugnance to fat, which is so often manifested 
by the phthisical, is unfortunate since it is so necessary as a force 
furnishing food. The frequency of phthisis in clerks, printers, 
tailors, milliners, seamstresses and factory employees, who live 
in a hot, close, dust laden atmosphere proves that bad ventila- 
tion, impure air, and an indoor life are strong predisposing 
causes. Of indoor workers those are most liable to phthisis who 
exercise least at their vocation. Compositors suffer oftener than 
the press hands in the same room. Prison and cloister statistics 
show a mortality from phthisis of from forty to fifty per cent, 
while that among the people at large is only fifteen per cent. From 
these considerations, it is evident that the feebleness of constitu- 
tion which predisposes to phthisis can be acquired as well as in- 
herited. Loomis is convinced that the phthisical development 
depends as much upon the anti- hygienic influences under which 
childhood has been passed as upon hereditary tendencies. 

Local Causes. — Loomis believes that bronchitis of the smaller 
tubes and chronic lobular (catarrhal) pneumonia are the starting 
points of a large number of cases of phthisis. The catarrhal 
condition of the mucous membrane in these cases furnishes the 
favorable soil for the development of bacilli. Loomis says, 
"That pulmonary phthisis not infrequently dates from a plewnsy 
is evident to every careful observer. " He also says that bronch- 
ial hemorrhage is frequently the first and only sign of phthisical 
development. The mechanical irritation of the bronchi pro- 
duced by the constant inhalation of an atmosphere laden with 
dust leads to phthisis. The phthisis of knife-grinders, stone- 
cutters, potters, and coal miners are examples of this. Pregnancy, 
instead of preventing phthisis, predisposes to it. According to 
Loomis, emphysema and goitre do not afford immunity against 
phthisis. The notion that malaria and marsh fevers are antag- 
onistic to phthisis is disproved by every day experience. 
Patients in whom all inflammatory processes tend to necrosis and 
suppuration are more liable to acute phthisis. Flint says that 



PHTHISIS. 413 

measles and typhoid fever leave the system in a condition favor- 
able for the development of tuberculosis. He also asks "Are 
they who suffer in early life from a scrofulous affection of the 
lymphatic glands of the neck especially prone to pulmonary tuber- 
culosis in after life"? He answers this question in the negative, 
and says " Assuming tuberculosis and the scrofulous cachexia to 
be identical as has been proved by the presence in both of the 
bacillus tuberculosis, it would seem that the predisposition is, as 
it were, exhausted by the affection in the glands of the neck, and 
that afterward it is not likely to occur. 

Flint believes that bronchitis, acute or chronic, has no ten- 
dency to eventuate in phthisis, and that acute pleurisy, lobar 
pneumonia, and bronchial hemorrhage have no causative relation 
to pulmonary phthisis. The opinion, which, is held by some 
writers, that chronic pharyngitis (which is an exceedingly com- 
mon affection in this part of the world), has a tendency to event- 
uate in pulmonary phthisis, is erroneous according to Prof. Flint. 
The sebum-like matter which is liable to accumulate in the 
glands of the tonsils and coughed up in the form of round hard 
pellets, is sometimes mistaken for tubercles. They emit a fetid 
odor when touched. Bartholow believes that one of the factors 
in determining tuberculosis of the lungs is a badly formed thorax. 
Flint does not believe this. Bartholow says: "Although the 
bacillus tuberculosis has been widely accepted as . the cause of 
phthisis, yet opposition is developing in various quarters." Dr. 
Spina, of Vienna, chief assistant to Strieker, opposes Koch at all 
points, and maintains that the bacillus has not a constant form, 
but varies with the tissue and local condition; that it is not 
essential to the tubercular process, and that it is frequently 
absent in undoubted tubercular disease. From the practical 
side, Koch^s theory has received a severe blow in two cases, 
which have recently occurred at Nothnagel's clinic. In both 
tuberculosis was diagnosticated, because the bacilli were detected 
in the sputa. Yet, on post mortem examination, both were ascer- 
tained to be examples of bronchiectasis, and no tubercles ex- 
isted at any point. It follows, from these facts, that the para- 
sitic nature of tubercular phthisis must be regarded as sub 
judice. The physician should not rush to the conclusion that the 



414 A COMPENDIUM OF PRACTICAL MEDICINE. 

parasitic nature of phthisis is proved (Flint, Loomis and Bartho- 
low). 

Symptoms. — Phthisis presents itself in a chronic and in an 
acute form. The chronic variety is by far the most frequent. It 
is essentially the "consumption" which is such a scourge to the 
human race. The harassing cough by day and by night; the 
impaired appetite and disturbed digestion; the loss of blood from 
the lungs; the steadily- augmenting debility; the short breathing; 
the exhausting night sweats; the hectic fever; the deceptive 
blush which this imparts to the cheek; the increased lustre of 
the eye; the singular hopefulness; the temporary improvements; 
the relapses; and the greater vividness of the imagination, so 
strongly contrasting with the waning frame — are phenomena 
with which sad experience has made not only every physician 
but many a fireside familiar (DaCosta). The most constant of 
all these symptoms are the hemorrhage, the cough and the ema- 
ciation. Phthisis is often remarkably insidious in its develop- 
ment. 

Cough — Of the pulmonary symptoms, the first which occurs 
is cough. The cough is at first and for some time slight, dry, 
hacking and perhaps it excites little or no attention. It contin- 
ues throughout the whole course of the disease. It may exist 
before there are any physical signs, and then there is little or no 
expectoration. It may amount only to a "clearing of the throat." 
The severity of the cough without expectoration is a measure of 
the extent to which the pleura is involved. The younger and 
more excitable the patient, the more paroxysmal is the cough. 
It is usually worse in the morning on rising or just after lying 
down at night. Lying on the affected side often brings on a vio- 
lent paroxysm. Some cough after the slightest exertion. In se- 
vere poroxysms of coughing, in the last straining effort to dis- 
lodge the sputa, vomiting is excited, an accident very apt to oc- 
cur after meals. The cough in the second stage usually becomes 
prominent. It may be less irritable and more exclusively for ex- 
pectoration. In advanced phthisis, where cavities have formed, 
the cough becomes "hollow" in character. The cough is very 
troublesome if the contents of the cavities are not easily evacu- 
ated (Bartholow, DaCosta, Flint and Loomis). 



PHTHISIS. 415 

Expectoration. — May accompany cough from its commence- 
ment. At first it is tenacious, glairy, frothy and mucous. As 
the disease advances it thickens. It becomes greenish in color, 
streaked with yellow, and " nummular " (consisting of large 
greenish masses of a rounded form, which masses do not sink in 
the cup containing them, but float imperfectly in a thin serum.) 
This expectoration is not pathognomonic of phthisis, as it may 
occur in chronic bronchitis. Dots and streaks of blood in ca- 
tarrhal sputa indicate a recent lobular pneumonia. The sputa 
in the earlier stages — often for months — are muco- purulent. 
When shreds of elastic tissue are found, it indicates softening 
and destruction of lung tissue. As cavities form, the sputa be- 
comes more purulent, sometimes being composed wholly of fluid 
pus, which may be fetid and greenish and contain small masses 
of cheesy matter and the tubercle bacilli. In the last stages of 
consumption the sputa may have a dirty- grayish aspect. The 
quantity of expectoration is very variable, amounting in some 
cases to only a few ounces, and in other cases to a pint or more 
daily. Sometimes the expectoration presents a thick, opaque 
appearance like that of pea- soup or gruel, or it may resemble 
boiled rice. The expectoration is usually more abundant in the 
morning than at any other time, owing to its having accumulated 
during sleep. Occasionally the matter expectorated and the 
breath of the patient emit considerable fetor, due to putrefac- 
tion of the contents of cavities (Bartholow, DaCosta, Flint and 
Loomis). 

Haemoptysis. — Is a very important symptom of phthisis, and 
may occur during any stage of the disease. It may be the first 
symptom. Haemoptysis is more frequent in the first stage, than 
in the second. The blood may simply streak the sputa, or a 
pound or more may be expectorated at one time. The blood is 
bright colored, more or less aerated, and comes up with cough- 
ing; but a sudden large hemorrhage may pour up in a stream 
and be ejected by the nose as well as the mouth. Hemorrhages 
that occur in the early stage of pulmonary phthisis are, in the 
majority of instances, bronchial, and the blood expectorated is 
arterial in color. When streaks of blood appear in the sputa, 
the bleeding usually comes from the vessels of the alveolar walls. 



416 A COMPENDIUM OF PRACTICAL MEDICINE. 

Profuse hemorrhage in the later stages of phthisis have their 
origin in cavities in the lung substance. Haemoptysis usually 
comes on with coughing. There is a sensation as if a fluid were 
trickling underneath the sternum, and there may be cardiac pal- 
pitation, oppressed breathing, and a peculiar sweetish and saltish 
taste in the mouth. For some time after the primary hemor- 
rhage, blood is coughed up, and the color of the spitting becomes 
darker. Sometimes without warning there is sudden filling of 
the mouth with hot arterial blood. In advanced phthisis 
hemorrhage may be the immediate cause of death. 

According to English writers, there may be a hemorrhagic 
phthisis. In this variety, an apparently healthy man has a sud- 
den and profuse hemorrhage, recurring daily for some time, fol- 
lowed by cough and slight expectoration for a few days, with no 
physical signs of consolidation. These cases often continue for 
years without any other phthisical symptoms, but sooner or later 
phthisis is developed. Tubercular disease of the vascular walls 
is the primary and chief event in such cases. Haemoptysis may 
occur in persons who do not have phthisis at the time, or who do 
not become phthisical afterwards. A pulmonary hemorrhage 
may be vicarious of the menstrual flow, and it may be determined 
by the sudden arre&t of hemorrhoidal bleeding (Bartholow, Flint 
and Loomis). 

Pain. — Pain in the chest does not belong to the disease 
per se; but it is liable to occur at times more or less frequently 
during the first stage of the disease, and is due to circumscribed 
pleurisy. Sometimes the pain is sharp, lancinating, or stich-like, 
referred to the summit of the chest, and frequently shooting 
beneath the scapula. The pleurisy is of the dry form, and seldom 
causes severe pain, but rather a sense of tightness and constric- 
tion^on taking a full inspiration. Intercostal neuralgia is fre- 
quent and may be confounded with the pain of a localized 
pleurisy. Pain on swallowing usually announces the co- exist - 
ence^of laryngeal phthisis. 

Respirations. — Are usually increased in frequency. It is 
apparent especially on exercise. The accelerated breathing is 
due to the fever, to the diminished breathing area, to bronchial 
obstruction, and to pain in the chest. Anaemia and heart-failure 



PHTHISIS. 417 

may also cause it. During the whole course of fibroid phthisis, 
shortness of breath on exertion is a constant symptom. 

Circulation. — During the first stage more or less accelera- 
tion of the pulse is the rule, and is an important diagnostic symp- 
tom. If the pulse be frequent the disease is likely to be rapidly 
progressive. In chronic phthisis the pulse is always feeble. It 
is accelerated by slight exciting causes. In the early stage of 
fibroid phthisis the pulse is rarely over 100. In the last stage of 
all varieties of phthisis the pulse becomes very rapid and feeble. 
The pulse is soft and compressible and the arterial tension low 

Fever. — Rise in temperature is so constant a symptom of 
phthisis that it has led to the expression, "there is no consump- 
tion without fever. 11 The fever course may be different in dif- 
ferent cases. The usual type of fever in the beginning is the 
quotidian. There is a daily morning remission and an evening 
exacerbation terminating in a sweat, the so-called hectic fever 
(septicamiic fever). Hectic fever may occur in any stage of 
phthisis, but is usually confined to the stage of softening and 
excavation. It has three stages: first, a well-marked chill or 
chilly sensation, lasting for a half to one hour; second, the chill 
is followed by dryness and heat of the surface, the temperature 
rising from 102° to 104° F. The face assuming a peculiar bril- 
liant appearance, and the cheeks having a peculiar rosy tint 
called the " hectic flush, 1 ' and third, the sweating stage comes on 
sometime in the night. The night- sweats are usually profuse 
and exhausting and always indicate the existence of hectic fever. 
The chills and fever may be absent but the sweats are constant. 
Sometimes there is a marked sensation of burning in the soles 
and palms. 

The type of fever may be double quotidian (two paroxysms 
of fever each day). In some cases the temperature in the 
morning may be subnormal, only reaching normal in the even- 
ing; in others the rise begins at 2 p. m., and continues until 8 
p. m., and then falls until 5 in the morning. As cavities form, 
the afternoon rise occurs later, at 10 to 12 at night. Toward the 
end of the disease the fever type resembles that of pyaemia. A 
normal temperature denotes that the disease is stationary or non- 
progressive, and a steady and continuous high temperature 



418 A COMPENDIUM OF PRACTICAL MEDICINE. 

denotes that it is progressive. The chills, the fever and perspi- 
ration may occur with such regularity that the patient is supposed 
to have intermittent fever. In fibroid phthisis the temperature 
rarely rises more than a degree or two above the normal. In 
the absence of local symptoms, the thermometer alone may 
detect pulmonary phthisis in the aged (Bartholow, Flint and 
Loomis). 

Emaciation. — Is an early and constant symptom of phthisis; 
but it is not always progressive. Fever is the chief cause of the 
wasting and pallor that are so common in all varieties of 
phthisis. The higher the average fever, the more rapid the ema- 
ciation. Wasting may occur before any local trouble of the 
lungs is detected. Emaciation may not be continuous in all 
cases; there are periods when the patient may even regain lost 
weight and muscular strength. The anorexia, dyspepsia, diar- 
rhoea, profuse expectoration and haemoptysis are all causes of 
tbe * emaciation. The wasting occurs not only in the fat and 
muscle, but in the organs and blood as well. Slow, gradual 
wasting belongs to the history of fibroid phthisis (Loomis). 

Disturbances in the Alimentary Tract. — In some cases there 
is almost entire loss of appetite, and even a repugnance to food. 
This is an unfavorable feature of the disease. Disorder of diges- 
tion is sometimes so prominent as to appear to be the chief 
malady. There may be nausea and vomiting, and pain in the 
stomach due to gastric catarrh. Diarrhoea may occur in the first 
stage. It may exist with, and without a tuberculous affection of 
the intestinal canal. Persisting or frequently recurring diarrhoea, 
accompanied by cough, be the latter never so slight, should ex- 
cite suspicion of pulmonary phthisis. Tuberculosis of the intes 
tines results from swallowing the expectoration. Tuberculous 
ulcerations are sometimes found in the large as well as in the 
small intestine. The ulcerations may lead to circumscribed per- 
itonitis. Perforation of the intestine may take place. The ulcer- 
ation may cause intestinal hemorrhage. Diarrhoea is a more 
prominent symptom in the second stage. It is usually most 
severe at night. If profuse, and watery, it is called colliquative 
dia/rrhcea. Colliquative diarrhoea occurs at an advanced period 
of the disease, although tuberculosis of the intestine does not 



PHTHISIS. 419 

exist. There may be tympanites. Hemorrhoids and fistula in 
ano are frequent troublesome complications of phthisis, and 
should always be relieved by surgical interference in the early 
stages of the disease. The cure of a fistula in ano or the heal- 
ing of an old ulcer is often followed by phthisical developments 
(Flint and Loomis). 

Menstruation. — Arrest of menstruation is a very frequent 
occurrence in females who are consumptive. In young females 
this is sometimes the first noticeable symptom. In advanced 
phthisis, it indicates extreme exhaustion, and is often followed 
by a more rapid progress of the disease (Loomis). 

Hoarseness. — Or huskiness, and sometimes extinction of the 
voice denote laryngitis, which may be developed in the first as 
well as in the second stage. Its occurrence is presumptive proof 
of pulmonary phthisis, the latter, as a rule, existing prior to the 
laryngitis (Flint). The pharynx is sometimes the seat of tuber- 
culous processes. A less constant symptom is the red line around 
the border of the gum. In some persons this gingival line is a 
mere streak; in others it is more than a line in breadth (Da- 
Costa). 

Clubbed Fingers. — The end of the finger is somewhat 
clubbed. The nails are curved and become claw like, prominent 
in the centre, depressed at the sides, their surface slightly 
cracked, their appearance bluish. This peculiar appearance is 
characteristic of phthisis, but is not pathognomonic. A similiar 
nail is seen in chronic pleurisy, and in diseases of the heart. 
Clubbed fingers are found in about twenty -five per cent, of the 
cases. 

Shin. — Is pale and traversed by prominent blue lines. The 
hair becomes thin, dry, gray and falls out. CEdema of the feet 
and legs is a frequent symptom of the second stage, denoting no- 
table failure of the circulation. At first it disappears on lying 
down, but at length it is permanent. Its occurrence indicates 
that a fatal issue is not far distant (Flint and Loomis). 

Cerebral Symptoms. — Are rarely pronounced in any stao-e 
of phthisis. There is no chronic disease in whieh the mind i> bo 
clear. The feelings are usually cheerful and buoyant. Patients 
are hopeful respecting their condition, and are readily persuaded 



420 A COMPENDIUM OF PRACTICAL MEDICINE. 

that they are improving, and hence • they fall an easy prey to 
quacks. They sometimes dislike to be told the truth, and take 
offense at an intimation that they are consumptive. The expec- 
tation of improvement, prolonged life, or even recovery, amounts 
in some cases to an insane delusion. Patients are sometimes 
occupied in forming plans for the future when it is obvious to an 
observer that they are on the verge of the grave (Flint and 
Loomis). 

Physical Signs. — 1. Of the stage of consolidation: Inspection 
reveals diminished expansion, on inspiration, in the supra- and 
infra -clavicular regions of the affected side. Palpation shows 
more distinctly the loss of expansion on the affected side, and 
increase of vocal fremitus over the consolidated lung. Percus- 
sion elicits relative dullness and sometimes even flatness. If the 
consolidation is slight, the percussion sound may remain normal. 
To recognize a slight consolidation at the apex of the lung, it is 
important to percuss from the trachea rather than toward it. In 
all cases percussion should be performed at the end of a full in- 
spiration and at the end of a full expiration. Auscultation 
shows increase of vocal resonance. Over the affected portion, 
the respiratory sounds maybe feeble or exaggerated, interrupted 
or wavy. In addition there are certain adventitious sounds or 
rales. The earliest of these audible is a fine, dry, crackling 
sound (sub -crepitant) appearing at the end of inspiration. 

The subcrepntant rales heard within a circumscribed space 
at the summit of the chest on one side are highly significant of 
tubercle. They proceed from secondary circumscribed bronchi- 
tis. A crepitant rale, in like manner limited to a small space at 
the summit on one side, has the same significance, being due to 
.secondary circumscribed pneumonitis. Crumpling and crackling 
sounds are significant, provided they be limited to the summit 
on one side. A pleural friction sound limited to the summit on 
one side denotes a secondary circumscribed pleuritis. 

2. Of the stage of softening and excavation. — Inspection 
shows a greater frequency of respiration and a more marked de- 
pression above and below the clavicle on the affected side, as well 
as increased difficulty in local expansion. In fibroid phthisis the 
retraction is more marked than in any other variety. Palptaion 



PHTJHISIS. 421 

shows diminished expansion of the affected side, on forced in- 
spiration. Vocal fremitus is increased. Percussion shows more 
uniform and widely spread dullness. Auscultation shows bron- 
chial breathing, and bronchophony becomes more distinct. 
Numerous, moist, crackling rales are heard. When cavities form, 
inspection shows greater depression in the infra -clavicular region 
and less expansive movements. Palpation shows intensified 
vocal fremitus over large cavities containing air and communi- 
cating with a bronchus. Percussion gives a tympanitic reso- 
nance, and the varieties of this resonance, called "cracked -pot" 
and amphoric, denotes cavities. If the cavity is filled with liquid 
there will be dullness on percussion. Auscultation. Over small 
cavities, cavernous respiration will be heard. Over large cavities 
near the surface amphoric respiration will be heard. The incom- 
ing air may bubble up and cause gurgles (Loomis and Flint). 

The Diagnostic Points Pertaining to Symptoms. — 1. Cough and 
expectoration, not succeeding an attack of acute bronchitis, and 
not connected with chronic pharyngitis, the cough at first dry 
and expectoration small and transparent, and becoming gradually 
more abundant and opaque. 2. /Stitch- pains at the summit, not 
connected with intercostal neuralgia. 3. Chills not referable to 
malaria. 4. Haemoptysis. 5. Accelerated breathing. 6. Loss of 
weight. 7. Pallor or anaemia not otherwise explicable. 8. 
Hoarseness, or huskiness of the voice proceeding from chronic 
laryngitis. 9. Chronic peritonitis not traumatic. 10. Suppres- 
sion of the menses. 11. Buoyancy of mind instead of despond- 
ency (Flint). 

Differential Diagnosis. — The diagnosis of pulmonary phthisis 
rests mainly upon an examination of the sputum and upon phvsi - 
cal signs. Incipient phthisis may be confounded with atonic 
dyspepsia. A cough may be present in atonic dyspepsia, the so- 
called stomach cough; but in this case there is no irritation about 
the air-passages. In advanced phthisis, hectic fever may be con- 
founded with intermittent. In phthisis, the fever has been pro- 
ceeded by a period of cough, and loss of flesh and strength, 
whereas in intermittent, these symptoms have followed the access 
of fever. In phthisis there is not enlarged spleen and the luetic 
is not arrested by large doses of quinine. Laryngeal symptoms 



422 A COMPENDIUM OF PRACTICAL MEDICINE. 

are often so pronounced in the beginning as to obscure the pul- 
monary affection. When tubercular deposits occur in the larynx, 
the tone and quality of the voice are quickly affected, so that the 
larynx may seem to be the only seat of tubercular deposit. The 
coexistence of pulmonary disease ought to be suspected, because 
of the relation known to obtain between them. 

Acute phthisis may be mistaken for croupous pneumonia, 
bronchiectasis and capillary bronchitis. In pneumonia the pro- 
longed ushering in chill, the continuous high temperature, the 
characteristic sputum, the dullness limited to a lobe, and the 
pneumonic countenance, are symptoms which readily distinguish 
it from acute phthisis. Bronchiectasis accompanied by wasting, 
fetid expectoration, haemoptysis, and night sweats with the phys- 
ical signs of consolidation, may well be mistaken for the ad- 
vanced stage of acute phthisis. But in phthisis the signs of con- 
consolidation precede those of cavities; in bronchiectasis they 
follow them. Fever and emaciation are always greater in 
phthisis than in bronchiectasis. In capillary bronchitis there is 
no dullness on percussion, subcrepitant rales are heard on both 
sides of the chest, and there is no bronchial character to the re- 
spirations. The early stage of chronic phthisis may be con- 
founded with bronchitis, pulmonary infarction, pleurisy, acute 
lobar pneumonia, anaemia with cough and expectoration and 
cancer of the lung. The evidence of consolidation of lung-tissue 
is essential to the diagnosis of phthisis. So long as bronchitis is 
accompanied by a temperature of 100° F., and the physical signs 
show that the bronchitis is general, phthisis is readily excluded; 
but if the temperature rises to 103° F., and localized crepitant 
rales develop at the apex of either lung, accompanied by dullness 
on percussion over the seat of the rales with a bronchial charac- 
ter to the respirations, then there is reason to believe that phthisis 
is being developed. The diagnosis between chronic bronchitis and 
fibrous phthisis rests upon the evidences of consolidation and 
retraction in phthisis, and their absence in bronchitis. Pulmon- 
ary infarction* are attended by haemoptysis and localized areas 
of dullness. Heart disease is their chief cause. The blood ex- 
pectorated in phthisis is of a bright scarlet color; in infarctions 
if is dark and in the form of coagula. Infarctions are most fre- 



PHTHISIS. 423 

quently situated in the lower lobes; in phthisis the dullness is 
apical. In pleurisy with effusion, flatness will exist from the 
base of the lungs to the level of the fluid; the line of flatness 
will change with a change in the position of the patient. The 
cough is more hacking and is not accompanied by expectoration, 
and vocal fremitus is diminished or absent. A localized pleurisy 
at the apex of the lung, not the result of a general pleurisy, is 
indicative of tubercular development. Anosmia with cough and 
expectoration is attended by no febrile symptoms, and by none 
of the physical evidences of pulmonary consolidation. In cancer 
of the lung there is usually bulging of the chest at the seat of 
the cancerous development; in phthisis there is retraction. In 
cancer the temperature is often subnormal; in phthisis it is more 
or less elevated. The currant- jelly expectoration of cancer is 
diagnostic. Pain is constant in cancer and intermittent in 
phthisis. 

The difference between caseous and tuberculous phthisis is as 
follows: Tubercular phthisis is distinctly hereditary; caseous 
phthisis is not hereditary, but occurs in the scrofulous. Tuber- 
cular phthisis occurs at all ages; caseous from youth to middle 
age. Tubercular phthisis occurs insidiously with catarrh of the 
bronchi and larynx; caseous results from acute inflammations of 
the bronchi and lungs. In tubercular phthisis the lesions are 
apt to be on both sides; in caseous on one side. The laryngeal 
symptoms are much more common in tubercular than in caseous 
phthisis. Fibroid phthisis is distinguished from the other forms 
by its slow progress, by the long period of bronchial troubles 
before the pulmonary lesions begin and by the merely purulent 
expectoration (Bartholow, Flint and Loomis). 

Prognosis. — The duration of phthisis is extremely variable. 
In the vast majority of cases it is essentially a chronic affection, 
but sometimes it runs a rapid course destroying life in a few 
weeks. The disease in such cases has been known as "galloping 
consumption," or phthisis florida, or acute phthisis. The prog- 
nosis of acute phthisis is always unfavorable. Its average dura- 
tion is from five weeks to five months. Flint distributes fatal 
cases into groups as follows: "One group will consist of cases in 
which the disease continues from three to six months; in another 



424 A COMPENDIUM OF PRACTICAL MEDICINE. 

group death takes place between six months and a year; and in 
a third group the career extends from one to two years; and in 
another group the fatal termination is held in abeyance for many 
years."" Flint says, u The generations of bacilli may die out or 
be destroyed, and the tuberculous products may be either ab- 
sorbed or calcification may occur. Cavities may completely 
cicatrize. In these modes complete recovery may take place. 
Cavities may exist without any fresh products, giving but little 
inconvenience for an indefinite period, and even through a long 
life." Of 670 cases analyzed by Flint, 44 ended in recovery, and 
in 31 cases, the disease became non-progressive. He claims the es- 
tablishment of the fact that in a certain proportion of cases 
phthisis is self limited. The most rational explanation of the 
manner in which this disease ends by self -limitation is to suppose 
that the conditions which are essential for the multiplication of 
the bacilli and which constitute the tuberculous predisposition or 
diathesis, after a time cease to exist. The vegetable parasite is 
destroyed because the soil becomes incapable of maintaining 
longer its existence. Persistent frequency of the pulse, fever, 
anorexia, and progressive emaciation oj3pose reliance on self- 
limitation. In proportion as phthisis is well tolerated there is 
room for hoping that it will prove self-limited. 

Haemoptysis \& very rarely an immediate cause of death. The 
disease proves fatal generally by asthenia. Bartholow says, 
"Phthisis is the great enemy of the human race since nearly two - 
sevenths of the deaths from all causes are due to this disease." 
He also says, "Cures are now not uncommon." 

Under prognosis Loomis says, "Chronic pulmonary phthisis 
is not necessarily a fatal disease. Its morbid processes may be 
arrested in the early stage or in the stage of cavities by proper 
treatment. Recovery has occurred in one- sixth of my recorded 
cases during the past ten years. The average duration of 
phthisis is three years and four months. Phthisis can in no sense 
be regarded as a self-limited disease. Some cases, after a period 
of activity, become stationary and then recover; others slowly 
but steadily progress to a fatal termination; others again pursue 
a more rapid and fatal course." The prognosis is unfavorable 
when there is a strong hereditary tendency, when phthisis de- 



PHTHISIS. 425 

velops early in life, when scrofulous or glandular disease has ex- 
isted in childhood, when the patient is narrow-chested, when the 
ordinary pulse rate is high, and when there is great variation in 
weight without any apparent cause. Frequent haemoptysis in an 
early stage of the disease is not unfavorable. When cedenia 
of the feet and lower extremities conies on in advanced phthisis, 
the prognosis is very unfavorable, and a fatal issue is not far off. 
Advanced cases may die suddenly from heart failure or syncope. 
The majority waste to a skeleton, but the mind is perfectly clear 
and the patient is hopeful of recovery, and makes plans for the 
future as if perfectly well (Bartholow, Flint and Loomis). 

Treatment. — The two main objects of treatment are the de- 
struction of the parasite and the removal of the tuberculous pre- 
disposition or diathesis. There are no known remedies which 
will accomplish either object. 

/. Prophylactic Treatment. — When a phthisical tendency 
exists, prophylaxis becomes highly important. It is possible to 
prevent the development of phthisis. Children born of phthis- 
ical parents should not be nourished in infancy by their own 
mothers, but should be placed with a healthy wet-nurse. During 
childhood they should be fed chiefly on good cow's milk, take 
systematic physical exercise in the open air, removed from the 
city to the country. They should not lead a sedentary life. 
They should not breathe air laden with foul vapors or fine par- 
ticles of dust. Their sleeping apartments should be large and 
well ventilated. Sudden changes in temperature must be 
avoided, also hot, crowded apartments. Change of climate may 
be necessary. All those agencies which tend to develop pulmo- 
nary hypersemia and bronchial catarrh should be avoided. 
Flannel should be worn next the skin the whole year. The diet 
should be simple and nutritious. Cold bathing should be prac- 
ticed every morning to diminish the susceptibility to cold. The 
"milk-cure" and " grape-cure" will often be useful. All milk 
fed to children should be boiled, and they should not be allowed 
to come in contact with phthisical parents, except under guarded 
conditions. 

//. Medicinal Treatment. — Alcohol. Clinical experience 
shows that alcohol, in a certain proportion of cases, has a salu- 



426 A COMPENDIUM OF PRACTICAL MEDICINE. 

tary effect. If alcohol produces a sense of comfort, increases the 
strength, and does not excite the circulation or nervous system, 
benefit maybe expected from its use; and vice-versa. As regards 
quantity, some patients will tolerate a large, some a moderate, 
and some only a small quantity. Phthisis is one of the diseases 
which in certain cases induce a remarkable tolerance of alcohol. 
Some patients are benefited by spirits, some by wine, and some 
by malt liquors, but in each case alcohol is the remedial princi- 
ple. Bartholow says: "Small doses of alcohol after meals (half 
an ounce for adults) are highly useful to promote appetite and 
tissue formation. Large quantities of alcoholic fluids impair the 
function of digestion, and lessen tissue forming.''' 

Cod-liver Oil. — The utility of cod-liver oil in incipient 
phthisis is very great. Its usefulness consists in the fact that it 
is a fat, having a special digestibility, owing to its containing 
bile elements. It is most useful in chronic tuberculosis and 
fibroid phthisis. It is better to give it with a little ether 
(IHxx.-5j.), because of the action of the ether in promoting the 
flow of pancreatic fluid. If cod- liver oil be taken without great 
repugnance, if it do not impair the appetite or digestion, or 
occasion derangement of the bowels, it may be expected to do 
good. 

Loomis says, "It has been claimed that if cod-liver oil is 
commenced very early it has the power of arresting the phthisi- 
cal processes. I doubt if it exerts any specific influence upon the 
disease. Unless the patient gains in weight while using the oil, 
it seldom or never proves remedial. A great gain in weight will 
sometimes immediately follow the administration of a small 
quantity of oil. It always acts remedially with more certainty 
in young persons and children than the aged. In some instances 
diarrhoea will be arrested by its use and also vomiting of food 
after eating. A teaspoonf ul once or twice a day is sufficient to 
commence with, the dose being gradually increased to a table- 
spoonful three times a day. Most patients take the oil best im- 
mediately or soon after meals." The pure oil is better than the 
emulsions and may be taken in whiskey or brandy to disguise its 
taste. The lacto'phxm'pliate of lime, if well prepared, is a most 
valuable agent in the treatment of incipient and the more chronic 



PHTHISIS. 427 

cases of phthisis. It may be given in a close of a tea- to a des- 
sertspoonful of the syrup three times a clay after meals with cod- 
liver oil. 

The hypophosphites are valuable agents to promote the con- 
structive metamorphosis. Arsenic is deserving of special com- 
mendation, in incipient phthisis, to promote the appetite and 
favor tissue building, while it corrects the disordered state of the 
stomach mucous membrane. It must be given in small closes, 
two drops of Fowler's solution three times daily. The iodide of 
iron and cod-liver oil will control the tendency to catarrhal 
attacks. In tubercular and fibroid phthisis, among the earliest 
symptoms are stomach disorders, poor appetite, atonic or acid 
indigestion, and especially repugnance to fatty elements of food. 
The mineral acids, with a bitter, such as tincture of nux vomica, 
are especially serviceable. If there be acid eructations, pyrosis 
and heart-burn, the mineral acids, especially dilute nitric (ten to 
fifteen drops, well diluted t. i. d.) should be administered before 
meals; but if the conditionbe atonic indigestion, the acicl should be 
given after meals. The nux vomica tincture should be given 
before meals — fifteen drops in water. Quinine. — In some cases 
of phthisis sulphate of quinine is one of the most reliable and 
satisfactory antipyretics. One tenth of a grain of morphine 
combined with the quinine increases its antipyretic powers 
(Loomis). Loomis also gives five grains of antifebrin two or 
three times in 24 hours to phthisical patients whose temperature 
ranges much above the normal, and finds that their appetites are 
improved during its use, and nervousness lessened. In many 
cases, after the disease has passed the first stage, the fever cannot 
be controlled. 

Couqh. — If the couo-h is verv distressing, o-aro'lino- the throat 
with a solution of bromide of potassium, or applying a mixture 
of chloral and camphor by means of a camel's hair brush to the 
fauces, and the atomization of a solution of cocaine or of mor- 
phine, are temporarily beneficial. FothergiU's prescription of 
hydrobromic acid diluted and spirits of chloroform sometimes 
acts well. A combination of codeine, atropine and strychnine is 
highly efficient as a remedy for cough, for night- sweats and 
reflex vomiting. Picrotoxin allays the vomiting which accom- 



428 A COMPENDIUM OF PRACTICAL MEDICINE. 

panies the cough almost as efficiently as strychnine. The patient 
should try to suppress the cough. The irritable feeling in the 
fauces may be allayed by a bit of gum arabic, candy, or troche. 
The officinal troche of licorice and opium, or of morphine and 
ipecac, may be used. Paregoric will often allay the cough. The 
inhalation of a few drops of chloroform will often control the 
cough. Ammonium carbonate in the infusion of wild cherry 
bark is one of the best stimulating expectorants, and it never 
nauseates. A solution of morphine in glycerine applied to the 
fauces with a brush, relieves the cough of phthisis. A better 
mixture is glycerine two parts, whiskey one part and crystalized 
sugar enough. This should be allowed to trickle slowly down 
the fauces. 

Tannic acid (gr. xx. to Siv. of aquae) is good in chronic 
throat troubles. It may be used as a spray. 

Night- sweats are a part of hectic. When quinine does not 
control them, quinine and opium may do so. Oxide of zinc (gr. 
ij-iv.) gallic or sulphuric acids, arseniate of iron (gr. \ to-J-), ex- 
tract of belladonna, or sulphate of atropia hypodermically, 
picrotoxine, ergot, all may be tried at different times. Atropia 
is the most reliable. Sponging the body with hot water, or 
vinegar and water, is sometimes effective. Sponging with as- 
tringent waters (alum in alcohol) is sometimes efficacious. 

Diarrhoea. — If the diarrhoea is dependent upon catarrh, 
with or without ulcerations in the small intestine, cod-liver oil 
and the hypophosphites of lime and socla will often be of ser- 
vice. Five grains of pancreatin given two hours after eating will 
often relieve the intestinal pain even in the later stages of the 
disease. Ten grains of bismuth, combined with a twelfth of a 
grain of morphine, after each movement, will almost certainly 
control the diarrhoea. If the diarrhoea depends upon ulceration 
of the large intestine, all that can be done is to give temporary 
relief by opium suppositories. When diarrhoea is persistent and 
accompanied by rapid emaciation, it is tubercular. For the 
diarrhoea, Bartholow gives two drops of Fowler's solution and 
ten drops of laudanum. Vomiting after meals is often a trouble- 
some attendent of phthisis. Champagne with the food, hydro- 
cyanic acid, and pepsin are useful, but the most certain relief is 



PHTHISIS. 429 

obtained by giving the patient a glass of hot water every two 
hours, followed in half an hour by a teaspoonful of raw scraped 
beef made into a sandwich. 

Creosote. — Bartholow thinks that from one to five minims of 
pure beech -wood creosote given three times daily, has distinct 
curative power in suitable cases of phthisis. 

Hcemoptysis. — The most valuable remedies for the arrest of 
haemoptysis are rest and opium. Lead, ergot and ice are recom- 
mended. Turpentine is more reliable than any remedy except 
opium. Local pains in the chest may be relieved by blisters, 
sinapisms, liniments or the belladonna plaster. 

Antiseptic Treatment by Inlialation. — Bartholow says, "The 
value of antiseptics by the method of protracted inhalation is 
just being recognized. The method consists in charging the air 
of a suitable apartment with a volatile remedy which the patient 
can breathe for a half to one hour or longer. I advise the inhal- 
ation by the protracted method of ethyl iodide, carbolic acid, car- 
bolic acid and^tincture of iodine, iodol, iodoform, oxygen, etc. 
The method of germicide treatment by rectal injection of sul- 
phurretted hydrogen, and carbonic acid, has fallen into disuse in 
this country. I hope I may not be considered egotistic and pre- 
judiced when I say that this mode (atomization of solutions) of 
using the remedies is not good — is not effective." 

Loomis says, " The antiseptic treatment of phthisis has not 
thus far given satisfactory results. Carbolized inhalations have 
been quite extensively employed with very favorable results ac- 
cording to some observers; but, after quite an extensive trial, my 
experience is decidedly against their use. The injection of cav- 
ities through the chest walls has not been followed by satisfac- 
tory results. I have found the hypodermic use of antiseptics to 
fail, not only in counteracting the sepsis, but in reducing the 
high temperature. I believe it is utterly futile to attempt to 
reach the bacilli imbedded in tubercular or caseous products." 
Again Bartholow says, "Cases of phthisis have been recently re- 
lated as cured by the inhalation of highly heated air. If the air 
is deprived of its moisture the temperature at which it can be in- 
haled ranges from 150° F. to 300° F. This method is based on 
the power of heat to inhibit or destroy the bacilli. It is proba- 



430 A COMPENDIUM OF PRACTICAL MEDICINE. 

ble that this mode of treatment will develop into a highly suc- 
cessful one." 

Hygienic Treatment of Phthisis. — Phthisical patients should 
sleep in large well -ventilated and well -lighted rooms with a 
southerly or westerly exposure. Flannels should be worn next 
the skin. Cold sponging or baths often act as tonics. The 
patient must live as much as possible in the open air, and should 
avoid sedentary occupations. 

Diet. — The diet should be generous as regards quantity, 
quality and variety. The articles should be highly nutritious 
and adapted to the digestive powers. Phthisical patients should 
drink from one to three quarts of milk each day. Cream, butter 
and sugar should enter into the diet as 'largely as possible. 

Change of Climate. — Bartholow says, "No change of climate 
can be beneficial, as a rule, after cavities have been formed, 
unless of slight extent. It is in incipient phthisis that a change 
of climate, dry, bracing and elevated, really exerts a curative 
influence. " Loomis says, "It is well known that some consump- 
tives thrive best in a warm, moist air, others in a cool, dry air; 
some are most vigorous in winter, others in midsummer. Each 
case must be carefully analyzed, before any definite directions 
can be given as to the climate best suited to it. We know of no 
climate which is entirely and absolutely antagonistic to its devel- 
opment. It was once thought that a warm, dry atmosphere 
alone was beneficial, but we now know that a cold climate not 
only does not hasten, but often arrests phthisical processes. The 
purity of the air is the chief reason that elevated regions are so 
beneficial in phthisis. Organic germs are more abundant in the 
air in the city than in the country. Rain and ozone free the air 
from them, the latter by oxidation. Rain cleanses the air of 
solid particles and purifies it by washing down ammonia and 
carbonic acid. The presence of ozone in the air is presumptive 
evidence of its purity. The air of high mountains and plateaux 
and along the shore of the ocean is richer in ozone than that of 
the plains. 

The benefit which phthisical patients derive from living 
near pine forests has long been known. Turpentine exhaled from 
pine or hemlock forests converts oxygen into ozone, and thus the 



PHTHISIS. 431 

air of pine forests becomes pure. Both sea and mountain air are 
cooler and less subject to frequent variations in temperature than 
the air of the plains. The question arises, will the patient be 
benefited by sea or by mountain air ? Patients with exhausted 
nervous systems, with an overtaxed brain from excessive mental 
labor, or an all-absorbing business, and who still retain consider- 
able muscular power should go to the mountains; while those 
past middle life, who have developed phthisis late, who are in- 
capable of much muscular activity do best in sea air. The 
health resorts of this country are those of Colorado, Minnesota, 
Southern California, Georgia, South Carolina, North Carolina, 
the Rocky Mountain regions and New Mexico. Loomis obtained 
the best and most permanent results in Asheville, N. C, in 
New Mexico, and in the Adirondack region of New York state. 

FIBROID PHTHISIS. 

In typical cases the lung is shrunken in size, with a corres- 
ponding retraction of the chest -wall and often a lateral deviation 
of the spine. In the substance of the lung there are firm, dense 
bands and masses or nodules of fibroid tissue, frequently deeply 
pigmented. Tubercles with cheesy centres are also usually 
present. This variety of phthisis is comparatively rare (Flint), 

Causes. — It is a disease of mature life, after the middle 
period, and is extremely rare before thirty (Bartholow). In the 
majority of cases the age of patients is under forty years (Flint). 
Next to heredity, chronic bronchitis and pleurisy are the most 
influential causes (Bartholow). 

Symptoms. — Fibroid phthisis is the most chronic form of the 
disease; its early history is that of bronchial catarrh, or of dry 
pleurisy; and it is not until after months, even years, that, exten- 
sion taking place to the lungs, the progress becomes more rapid. 
For months there is merely a dry cough, not very troublesome, 
but persistent. The expectoration is slight, and is nothing but 
mucus. The appetite is but little impaired, and the weight and 
strength are not materially reduced. The symptoms increase in 
severity during the fall, winter and spring months for two or 
three years; then fever comes on toward evening, the appetite 



432 A COMPENDIUM OF PEACTICAL MEDICINE. 

lessens, digestion becomes poor, the weight declines, the cough is 
harassing and prevents sleep, the expectoration becomes more 
profuse and entirely purulent; there is some difficulty of breath- 
ing, the pulse is small and weak, and finally slight chilliness is 
felt in the morning, fever in evening, and sweating occurs during 
the night. When the bronchi dilate, the expectoration becomes 
profuse, especially in the morning — a cupful or more may be 
brought up in an hour or two. The sputum usually contains 
tubercle bacilli. The matter expectorated is often notably fetid. 
The fingers often become clubbed (Bartholow and Flint). 

Physical Signs. — As regards physical signs, they are the same 
in all forms of phthisis. 

Differential Diagnosis. — Fibroid phthisis is distinguished from 
the other forms by its slow progress, by the long period of 
bronchial troubles before the pulmonary lesions begin, by the 
merely purulent expectoration, and by bronchial dilatation long 
before the cavities by excavation form. The initial period, ter- 
minating in a bronchiectasis, may occupy a number of years; at 
first for several years, there is winter cough only, the warm 
season being free or nearly so (Bartholow). 

Prognosis. — The most chronic of all the forms of phthisis is 
the fibroid. The course of this disease may occupy several 
years, indeed, an ordinary lifetime, and prove fatal at last, as it 
involves lesions which do not admit of recovery (Bartholow). 

Treatment. — Same as in the other forms. 

ACUTE MILIARY TUBERCULOSIS. 

Is characterized by the presence of miliary tubercles in most 
of the organs of the body. The organs almost constantly affect- 
ed are the lungs, the liver, the spleen, the medulla of the bones, 
the kidneys, thyroid gland, the heart, the choroid coat of the 
eye, the lymph-glands and the serous membranes (Flint). 

Causes. — It is caused by the entrance of tubercle bacilli 
into the blood current, and their transportation to most parts of 
the body. All varieties of local tuberculosis may be followed 
by acute miliary tuberculosis. It frequently develops in persons 



TUBEBCULOSIS PLETTBISY. 433 

i 

apparently in perfect health. All tubercles contain bacilli 
(Flint). 

Symptoms. — Cases of this disease are rare; they occur mostly 
after puberty and before the middle period of life. The general 
symptoms denote a febrile disease. The disease sets in with a 
chill, a rather rapidrisein temperature from 103° to 107° F., with 
remissions and a rapid pulse 120 to 150, small, soft and compres- 
sible. The respirations are from fifty to sixty per minute. Cough 
is more or less prominent. There is complete anorexia and the 
prostration is great. The circulation in the extremities is feeble; 
the finger nails are blue, the lips and nose have also a cyanotic 
hue, and the countenance soon becomes dusky. The tongue be- 
comes dry; sordes accumulate about the teeth; food is rejected; 
tympanites and diarrhoea supervene, the stools have a light yel- 
low color; there is delirium of a low muttering character and 
stupor comes on which soon passes into coma. The cases, as a 
rule, present a striking analogy to typhoid (Bartholow and 
Flint). 

Prognosis. — Is unfavorable. The duration of the disease is 
from a few days to six or seven weeks, with an average of three 
weeks (Loomis). 

Treatment. — The consideration of the treatment of acute 
miliary tuberculosis is a rather barren subject, since it does not 
appear that any remedy has the least influence over the disease. 
The condition of the patient is hopeless, and all that the physi- 
cian can do is to palliate symptoms and sustain the powers of life. 
This is one of the diseases in relation to which recovery is proof 
of an error in diagnosis (Bartholow and Flint). 

PLEURISY. 

Called also pleuritis, is an inflammation of the pleural mem- 
brane. It may run an acute, sub -acute, or chronic course, and 
have for its products fibrin, serum and fibrin, serum, fibrin and 
pus, or new connective tissue. It may he primary or secondary 
to some other disease (Loomis). 



434 A COMPENDIUM OF PRACTICAL MEDICINE. 

Pathological Anatomy. — Normally the pleural membrane 
is smooth, polished and covered with a single layer of en- 
dothelial cells. The pleural cavities contain normally a small 
quantity of serum. The first noticeable change in pleuris^ 
or pleuritis is redness of the pleura from active hyperemia 
of the vessels. Small extravasations of blood may take place 
on account of the blood pressure. The pleura loses its 
glistening appearance, and becomes dull, opaque and rough; 
the endothelial cells are rapidly cast off. Very soon the surface 
of the pleura becomes covered with a fibrinous exudation and it 
becomes rough and shaggy in appearance. 

The opposing surfaces of the pleura 'may be agglutinated by 
the fibrin. If any serum exudes it gravitates to the most de- 
pendent portion of the pleural sac. Those are examples of dry 
pleurisy, in which a very plastic exudation is throwm out on the 
two surfaces over a small extent of the membrane, union taking 
place, there being no other effusion. More commonly, the pleu- 
risy is of the sero -fibrinous variety. In this variety, in addition 
to the fibrinous coating of the pleura, the cavity contains serum, 
varying in quantity from a few ounces to several pints. When 
pus- cells accumulate in sufficient number, the exudation becomes 
purulent and the disease is called suppurative pleurisy or 
empyema (see empyema). The red blood corpuscles may be so 
abundant as to stain the fluid red; it is then called hemorrhagic 
pleurisy. In from four to six days after the onset of the inflam- 
mation newly formed capillaries, which are off- shoots from the 
pleural capillaries, make their appearance in the deeper parts of 
the layer of fibrin and cells covering the pleura. The termina- 
tions of acute pleurisy are either in death, in resolution, in 
chronic pleurisy, or in empyema. It will be noted that after 
the most favorable termination of pleurisy the pleura does not 
return to its normal state, but is left with a new growth of con- 
nective tissue which binds the pleural surfaces together over a 
greater or less extent. In this way the pleural cavity may 
become entirely obliterated by adhesions. The adhesions are at 
first weak, and may be broken by active exercise or by acts of 
coughing. Chronic pleurisy differs only in time and extent from 
the acute form. In pleurisy deformans the exudations are of 



PLEURISY. 435 

great thickness and extent, and by adhesion and subsequent con- 
traction, extensive deformity of the lung may result. Pleurisy 
may be general or circumscribed (Bartholow, Flint andLoomis). 

Causes. — Pleurisy may be primary or secondary. Exposure 
to wet and cold has been regarded as one of the most frequent 
causes of primary pleurisy. It may result from a penetrating 
wound, or blows upon the chest wall, or fracture of the ribs. It 
is common in early life up to the middle period, but is uncom- 
mon in old age. It is secondary to lobar and lobular pneumonia, 
pulmonary tuberculosis, infarctions, abscesses and gangrene of 
the lung, bronchitis, pericarditis, etc. Pleurisy is a frequent 
complication of many infectious diseases, such as scarlatina, var- 
iola, pyaemia, septicaemia, acute rheumatism, Bright's disease, 
scorbutus and gout. Pus is usually formed in the pleurisies of 
children (Bartholow, Flint and Loomis). 

Symptoms. — Acute pleurisy may be mild or severe. There 
are three stages. The first stage is the period from the attack 
to the time when effusion takes place. The second stage will 
extend to the time when the liquid begins to diminish. The 
third stage is the time occupied in absorption of the liquid. The 
first stage rarely extends beyond twenty-four hours; the second 
and third stage are variable. Acute pleurisy with effusion, the 
ordinary form, sets in as any other acute inflammation, with 
chill, general malaise, and fever with pain in the side. There 
may be a well -pronounced chill, but more often chilly sensations 
for the first few days. The pain is usually acute, lancinating, 
circumscribed, and is increased by breathing, coughing, or abrupt 
movements of the body. It is felt at the side of the chest, some- 
times at the base of the thorax, occasionally in the lumbar and 
iliac junction. It may be covered with a finger or two. It is 
commonly called "stitch in the side. 17 The pain may be diffused 
and ill- defined. It may cease in three or four days, or continue. 
The respiration is hurried and difficult. The fever, may continue 
with little variation for about eight days. The temperature in 
ordinary cases rarely rises above 100° F.; but in very severe 
cases it may reach 104° F. 

Cough is usually present, but is sometimes wanting. It is 
usually suppressed on account of pain. It is a dry, short, tear- 



436 A COMPENDIUM OF PRACTICAL MEDICIJSTE. 

ing, hacking cough. When effusion comes on, the cough de- 
clines. The expectoration is slight or wanting, and when pres- 
ent it consists only of a little frothy mucus. The decubitus of 
the patient is highly characteristic. Before effusion has taken 
place the patient lies on the sound side; but when the effusion 
begins to compress the lung the patient lies on the diseased side. 
If a considerable amount of liquid be rapidly effused the respira- 
tions are rapid; the patient suffers from a painful sense of tha 
want of air or dyspnoea, and may be obliged to maintain the sit- 
ting posture. The pulse is accelerated, beating from 90 to 120 
per minute. The countenance has an expression of weariness, 
anxiety and exhaustion and may be pale or cyanosed. It is a 
unilateral disease — that is, it affects the pleura of one side only 
(Bartholow, Flint and Loomis). 

Physical Signs, — During the first 24 hours of acute pleurisy, 
inspection shows restrained movements on the affected side, pal- 
pation, percussion, and mensuration will give negative results. 
On auscultation the respiratory murmur will be found feeble 
over the affected side, and a grazing friction sound will be 
heard. As the plastic exudation takes place inspection will show 
a, greater loss of expansive motion on the affected side ; palpation 
shows diminished vocal fremitus; percussion gives slight dull- 
ness: auscultation shows feeble respiratory murmur, and a fric- 
tion murmur will be heard on inspiration and expiration. If the 
pleurisy is confined to the pleura of the diaphragm or medias- 
tinum the friction sound will not be heard. When there is con- 
siderable effusion, inspection will show more restricted move- 
ments; palpation shows absence of vocal fremitus at the bottom 
of the pleural cavity, (on the sound side the vocal fremitus is 
exaggerated); on percussion, dullness or flatness is found at the 
base of the chest, and the finger which serves as a pleximeter, 
feels an increased sense of resistence. Changing the position of 
the patient changes the line of dullness. The resonance overtjae 
lung above the level of the liquid is increased, constituting 
vesiculo- tympanitic resonance. On auscultation the respiratory 
sound will be absent below the level of the fluid, and feeble 
above it. (In health the vocal fremitus is greater on the right 
side). When the pleural cavity is completely filled with fluid, 



PLETTEISY. 437 

inspection will show an enlargement of the affected side, and a 
bulging of the intercostal spaces. On the sound side the respir- 
atory movements are increased. If the effusion is in the left 
pleural cavity, the heart will be displaced to the right, and the 
apex-beat may be noticed under the right nipple; if it occupies 
the right pleural cavity the apex-beat will be carried to the left, 
beyond its normal position. The circumference of the affected 
side at the end of expiration, will be one or two inches greater 
than that of the healthy side; but at the end of inspiration the 
difference will be but slight. Palpation shows absent vocal 
fremitus, or in rare cases vocal fremitus may persist and even be 
increased. Percussion shows flatness. Auscultation shows entire 
absence of the respiratory sounds, and vocal sounds will be dis- 
tant and indistinct. At the upper portion of the pleural cavity 
bronchial respiration and bronchial voice, or bronchophony will 
be heard. As the fluid is absorbed the friction murmur returns, 
and is sometimes so loud as to be heard by the patient himself 
(Bartholow, Flint and Loomis). 

Differential Diagnosis. — Pleurisy may be confounded with 
pneumonia, intercostal neuralgia and pleurodynia. Pleurisy 
begins by chilliness, which persists for several days — pneumonia 
by a severe rigor, rarely two; the pain in pleurisy is a stitch, a 
lancinating pain, which can be covered by the finger, pneumonia 
by a sense of soreness and pain much more diffused; the fever in 
pleurisy is continuous — in pneumonia there is a distinct crisis or 
lysis, somewhere from the fifth to eleventh day; the duration of 
pleurisy is indefinite — of pneumonia self -limited; the expectora- 
tion of pleurisy is simply frothy mucus — of pneumonia rusty or 
bloody; in pleurisy the vocal fremitus is absent — in pneumonia 
it is not only present but exaggerated; in pleurisy there is a fric- 
tion sound, no crepitant rale, and the bronchophony is not so 
well defined — in pneumonia there is no friction sound, the crepi- 
tant rale is present, and bronchophony is loud and clear; in 
pleurisy with effusion there is more decided dullness, the inter- 
costal spaces are pushed out, and the thorax enlarged; in pneu- 
monia the percussion note is not so fiat, the intercostal spaces 
and the size of the thorax remain normal. Intercostal new*algia 
denotes a neuralgic affection of the intercostal nerves. The term 



438 A COMPENDIUM OF PRACTICAL MEDICINE. 

pleurodynia is applied to a painful affection of the muscles of 
the thorax. Both affections may be characterized by pain resem- 
bling that of either acute pneumonia or pleurisy; that is, a lanci- 
nating pain felt especially in the act of inspiration. They may 
be accompanied by a dry cough which is acutely painful. In 
cases of pleurodynia there may be pyrexia, and this may acci- 
dentally exist in cases of intercostal neuralgia. But intercostal 
neuralgia, as a rule, is not accompanied by pyrexia, and has 
three isolated points of tenderness, namely, behind, near the 
dorsal vertebrae; laterally in one, two or three intercostal spaces; 
and anteriorly, in one or more intercostal spaces near the sternum 
or over the epigastrium. In pleurisy there are signs denoting 
effusion and a friction murmur. Pain in pleurodynia and inter- 
costal neuralgia is more marked, as a rule, in movements of the 
body than in the respiratory movements, the reverse being true of 
the pain of pleurisy and pneumonia. Persons affected with 
intercostal neuralgia are frequently anaemic, and sometimes 
tubercular (Bartholow and Flint). 

Prognosis. — The tendency is to recover. 

Treatment. — In the first stage, the patient should receive a 
full dose of quinine (gr. xx.) and morphine (gr. ss.) for an adult, 
and the effect of this kept up by HYe grain doses of quinine 
combined with gr. -J- of morphine every four hours. Besides the 
power of morphine to relieve pain, it is an effective remedy in 
serous inflammation. By relieving pain opium diminishes the 
determination of blood to the inflamed part; for pain is alone 
sufficient to occasion an increased afflux of blood to a part. 
Opium places the system in a condition to tolerate better the 
local affection. Aconite is a valuable sedative remedy in the 
early stage of this, as of other acute inflammations. It should be 
given in drop doses of the tincture every fifteen minutes for two 
hours, and then hourly. Saline purgatives should be given. 
When the exudation is poured out, carbonate of ammonia in a 
solution of the acetate (gr. v.-x. in Sss.) should be given. They 
should take the place of the quinine and morphine. Saline laxa- 
tives must be given, and once a day gr. | of pilocarpine may be 
administered to keep the skin active. 



PLEURISY. 439 

Diuretics are sometimes effective in removing the effusion. 
Half an ounce of the infusion of digitalis, freshly made from 
English leaves, given three or four times a day, with the bitar- 
trate or acetate of potassium, is highly effective. The quantity 
of fluid ingested should be as small as possible. According to 
Loomis, if the patient presents the signs of anaemia, the syrup of 
the iodide of iron should be given in teaspoonful doses three or 
four times each day. Loomis says: "The remedial agent which 
seems to me to have the greatest power in promoting the absorp- 
tion of an effusion is the syrup of the iodide of iron." The diet 
should be nutritious, tonic remedies are useful, and a little wine 
or spirit may be allowed. 

Going out of doors and gentle exercise are to be encouraged. 
Counter irritation may do good. Cod-liver oil and extract of 
malt may be given, and the digestion stimulated by bitters and 
mineral acids. When a large effusion exists, especially if puru- 
lent, it becomes necessary to remove it by the operation of 
thoracentesis (see empyema). As death has occurred several 
times very unexpectedly after the operation of thoracentesis cer- 
tain precautions are necessary. When the effusion is large, the 
whole amount should not be withdrawn at once (Bartholow, 
Flint and Loomis). 

PRESCRIPTIONS FOR PLEURISY. 

R Morhpise sulphatis gr. i. 

Quinise sulphatis gr. xv.-xx. — M. 

Ft. pulv. no. 1. 
Sig. : Take at once. (To abort a beginning pleurisy) . 

— Bartholow. 

R Tinct. opii deodoratse 3vj. 

Tinct. aconiti radicis 5ij. — M. 

Sig. : Eight drops in water every hour. (In acute pleurisy be- 
fore effusion). — Bartholow. 

R Tinct. iodini comp oiij. 

Sig. : Divide the affected surface into three sections and paint 

one section every day. (For chronic pleurisy with effusion). 

— Bartholow. 
R Potassii iodidi oiv. 

Aqua} 3 vj . — M. 

Sig. : Take one teaspoonful in milk three times a day. 



440 A COMPENDIUM OF PRACTICAL MEDICINE. 

PNEUMONIA. 

Is an inflammation of the pulmonary substance or paren- 
chyma. Pneumonia is the name commonly used, but pneu- 
monitis is the more appropriate term. The parenchyma of the 
lungs is composed of pulmonary lobules which are composed of 
air cells, infundibula, alveolar passages and bronchioles. A 
bronchus after it enters a lobule is called a lobular bronchus or 
bronchiole. It divides dichotomously once or twice, and termi- 
nates in the alveolar passages, into which open the air cells, air 
vesicles or alveoli. The alveolar passages also divide a few 
times, and end in funnel shaped spaces called infundibula, the 
walls of which are composed of thickly placed air vesicles. 
Pneumonia is known in common language as " lung fever," 
" winter fever," etc. (Flint). 

Varieties, — I Acute lobar pneumonia called by German 
writers croupous pneumonia, by French writers fibrinous pneu- 
monitis, and by others pneumonic fever. II. lobular, catarrhal 
or broncho -pneumonia and III. JEmbolic pneumonia, suppura- 
tive pueumonia or abscess of the lung (Flint). 

Acute lobar or croupous or fibrinous pneumonia or pneu- 
monitis is an acute general disease characterized by an inflam- 
mation of the vesicular structure of the lungs, with an exudation 
into the alveoli which renders them impermeable to air. A sin- 
gle lobe, the whole of a lung or both lungs may be simultane- 
ously involved (Loomis). 

Morbid Anatomy. — Lobar pneumonia may be divided into 
three stages. 1. A stage of congestion or engorgement, or 
hyperemia. 2. A stage of consolidation or red hepatization. 
3. A stage of gray hepatization. Another division is into the 
stage of congestion; the stage of exudation (red hepatization); 
the stage of resolution (degeneration and extrusion of the exu- 
dation); and the stage of purulent transformation (gray hepatiza- 
tion). 

In the stage of congestion, there are an increased blood 
supply and the pouring out of an exudation. The lung does not 
collapse when the thoracic cavity is opened, has a reddish-brown 
appearance, is heavier, floats in water, but sinks lower than the 



PXEUMOXIA. 441 

normal lung, crepitates but little when pressed, and is no longer 
elastic. On section a thin, frothy, blood-stained serum exudes. 
It may be tenacious. 

In the stage of exudation or red hepatization, there is a 
pouring out and coagulation of the exudation. There is exuded 
into the alveoli and bronchioles an albuminous or fibrinous fluid 
of great viscidity, and with it leucocytes which have wandered 
from the vessels, and red-blood -corpuscles present by diapedesis, 
and blood by the rupture of distended capillaries. In the cap- 
illaries of the inflamed area the blood current is finally stopped. 
The albuminous or fluid exudation remains fluid for a short 
time, and then solidifies or coagulates. When this process is 
completed, the inflamed part is solid, entirely without air, and 
falls immediately to the bottom when placed in a vessel of water. 
The volume of the affected lung is increased; so much so that it 
often bears the impress of the ribs. The lung is friable, easily 
torn and non- crepitant. On section a dirty red viscid fluid oozes 
from the surface. The cut surface has a reddish color, and is 
granular, resembling liver -tissue. This granular appearance is 
due to the little masses of coagulated exudation filling the cavity 
of the alveoli. The granules can be lifted out of the mold in 
which they are formed by means of a fine needle. There are two 
directions which the inflammatory process may now assume: to- 
ward resolution, or toward purulent transformation. When 
resolution takes place, the albuminous material which had solidi- 
fied undergoes liquefaction, the watery parts being absorbed and 
the solid expectorated. 

When the purulent transformation takes place, there is a 
change in the density and color of the affected lung. The pus- 
cells become numerous. The consistency becomes less and less 
until the tissue is a mere pulp, readily breaking down on pres- 
sure. On section the surface presents a uniformly dirty gray 
appearance. On slight pressure a reddish gray or dirty white 
puriform fluid flows from the cut surface. The granular look of 
the second stage has disappeared. 

Termination. — Lobar pneumonia may terminate in: 1. Reso- 
lution. 2. Suppuration. 3. Abscess. 4. Gangrene. 5. Chronic 
pneumonia. 



442 A COMPENDIUM OF PRACTICAL MEDICINE. 

Abscess may follow suppuration. These abscesses vary in 
size from that of a pea to one which may occupy an entire lobe. 
They may open into the pleural cavity. Gangrene occurs in 
about two per cent, of all cases. It is liable to occur when there 
is great constitutional weakness, and in chronic alcoholismus or 
in septicaemia. In childhood, except before the second year, 
croupous pneumonia is rare. Double pneumonia is more frequent 
than in adult life. In old age, the pneumonic process usually 
begins in the upper lobes. Gangrene is far more frequently a 
termination of lobar pneumonia in old age than at any other 
period. It is a law of the disease that lobar pneumonia attacks 
the lower lobe of the right lung most frequently; the next most 
frequent seat is the lower lobe of the left lung; then the upjoer 
lobe of the right, the middle lobe of this lung being least fre- 
quently involved. According to statistics of Juergensen the 
right lung was affected in 53.7 per cent., the left lung in 38.23 
per cent., both lungs in 8.07 per cent. According to Bartholow, 
the inferior lobe of the right lung is the point of election, being 
the seat of the inflammation in three -fourths of the cases. Ac- 
cording to the analysis of 121 cases by Dr. Flint, in 29 cases it 
was limited to the lower lobe of the right, and in 25 cases to the 
lower lobe of the left lung. It extended over the whole of the 
right lung in 27, and over the whole of the left lung in nine 
cases. It was limited to the upper lobe of the right lung in 
eight, and to the upper lobe of the left lung in three cases. It 
was seated in the lower lobe of both lungs in eight cases. 

The name u crossed pneumonia" has been applied to the 
disease when the lower lobe of one lung and the upper lobe of 
the opposite lung are affected. Double pneumonia occurs in 
from 5 to 15 per cent, of cases, and is more frequent in senile 
than in the adult period of life. According to Loomis the stage 
of congestion lasts from one to three days; red hepatization from 
three to seven days; and gray hepatization from two to thirteen 
days. In old age the stages merge rapidly into each other; 
abscess of the lung may occur within 36 or 48 hours after the 
onset. Over a pneumonic lung there is usually a circumscribed 
pleurisy. In a strict sense, nearly every case of pneumonia is a 
pleuro-pneumonia (Bartholow, Flint and Loomis). 



PNEUMONIA. 443 

Causes, — Among the predisposing causes age ranks first. 
There are three periods in life in which the liability to pneumo- 
nia is greatest : early childhood; 20 to 40; and after 60. From 
reliable data it appears that lobar pneumonia is Hve times more 
frequent in the first two years of life than in the whole succeed- 
ing eighteen. Xine- tenths of all deaths after the sixty -fifth 
year are caused by lobar pneumonia. The disease occurs much 
oftener among males than females. In-door life, a vitiated at- 
mosphere, excesses, especially alcoholic, and bad hygienic 
influences of every kind which induce debility favor attacks of 
pneumonia. Frequently the attack is excited by some unusual 
exposure, such as working in the cold and wet or sleeping out of 
doors at night. Diphtheria, measles, erysipelas, small-pox, and 
other acute infectious diseases must be regarded as predisposing 
causes. One attack of pneumonia predisposes to others; twenty- 
eight attacks have been noted in one individual. Pneumonia 
may follow a severe blow or injury to the chest or shock from 
any traumatic cause. In the aged, lobar pneumonia has devel- 
oped as soon as four hours after fracture in the hip joint. Those 
parts of the year characterized by humidity, high winds and Ioav 
temperature invite the disease. In this country it prevails most 
in winter and spring. Pneumonia is unknown in the Polar 
regions. North and east winds favor its development. 

Loomis gives the following facts which tend to prove that 
lobar pneumonia is not a local malady: " Cold does not influ- 
ence the prevalence of pneumonia as it would were it a local 
disease (e. g. bronchitis). Wet and cold increase a bronchitis 
but not a pneumonia rate. Lobar pneumonia is more prevalent 
in our Southern than in our Northern states, affecting especially 
the negro population, and often proves the scourge of cotton 
and sugar plantations. The prevalence of pneumonia increases 
from pole to equator. All acute general diseases increase with 
the population, pneumonia does this. Statistics show pneumonia 
to be more frequent in Xew York City now than twenty years 
ago. Again, there is no relation between the amount of lung 
involved and the intensity of the symptoms. In local in ii anima- 
tions the reverse of this is true. No second chill occurs when 
another lobe is attacked. The absence of a known period of in- 



444 A COMPENDIUM OF PRACTICAL MEDICINE. 

cubation, of a typical temperature range, and of characteristic 
surface phenomena, and the fact that the disease is not contagious 
are the reasons advanced by those who regard it as a local, not a 
general disease. 

The resemblances of pneumonia to acute general diseases 
are: distinct chill, an orderly pyrexia, a rather typical course, 
i. e. a day of abrupt crisis, a definite duration, and the symptoms 
following in regular sequence. There is a peculiar facies; an oc- 
casional herpetic eruption; nephritis is not rare; the cerebral 
symptoms resemble those of the exanthemata; there are sweats 
and sudamina; and its mode of commencement. Coma in the old 
and convulsions in the young indicate that it is an acute general 
disease. We have abortive cases of pneumonia, just as we have 
abortive cases of typhoid. Pneumonia is allied to acute general 
diseases by the fact that certain complications occur. It is some- 
times a disease of intra-uterine life. No local disease occurs in 
the fetus. The success of modern methods of treatment based 
on this belief bears evidence to its being a general, self -limiting, 
acute febrile disease. Pneumonia is thus admitted to be a gen- 
eral constitutional disease with local manifestations. It seems 
probable that the real exciting cause is a microbe (Bartholow, 
Flint and Loomis). 

Symptoms. — /. Subjective Symptoms. — For a day or longer 
there may be malaise, anorexia, headache, dull pains in the limbs, 
back and lumbar region, vertigo, epistaxis, slight diarrhoea or 
jaundice, and flashes of heat and rigors. In most cases the in- 
vasion is sudden, and the disease is ushered in by a distinct chill. 
Generally the patient is seized with a chill in the night. This 
chill is intense and prolonged, more so than in any other disease 
except pyaemia and malarial fever. It lasts from one -half to 
three hours. Its abruptness and violence are characteristic. A 
distinct chill is less frequent in the pneumonia of old age; yet 
when an old person has a marked chill pneumonia may always 
be suspected. The initial chill is rarely repeated. A child may 
awake in the night with a burning skin, bounding pulse, flushed 
face and hacking cough as the first symptoms. With the initial 
symptoms there are rise in temperature, pain in side, accelerated 
breathing, dyspnoea, cough, expectoration, flushed and anxious 



PXEUMOXIA. 445 

countenance, headache, loss of appetite, intense thirst, scanty 
urine, and heavily- coated tongue. The symptoms increase until 
the day of crisis, when they either suddenly remit and the patient 
breaks out in a profuse sweat, or they subside by lysis. The 
defervescence is usually reached between the fifth and ninth day. 
II Objective Symptoms. — 1. Hespiration is more con- 
stantly increased in frequency in pneumonia than in any other 
acute disease, and varies from 30 to 80 per minute. The resjDira- 
tions may be 80 per minute and the pulse rate not more than 100. 
The acceleration is not in proportion to the amount of lung in- 
volved. It is panting, not catching in character. It may or may 
not be accompanied by dyspnoea. Expansion of the nostrils is an 
early symptom in the pneumonia of children. 

2. Dyspnoea is by no means constant. It does not depend 
upon the amount of lung involved. It is often so great that the 
patient is unable to lie down. The greatest dyspnoea occurs 
where there is marked nervous prostration, and in complicated 
pneumonia. In children dyspnoea is most marked when the apex 
of the lung is involved. 

3. Pain follows the chill. It is situated under the nipple 
of the affected side. It is sharp and stabbing, often located over 
the pneumonic spot, and is intensified by coughing, sneezing, 
and deep inspirations. It is the pleurisy that causes the jDain. 
Pneumonia itself is a painless disease. Pain in the affected side 
rarely continues beyond the third or fourth day. If it continue 
beyond the eighth day it is evidence of pleuro -pneumonia. It is 
present in 85 per cent, of all cases. In old age pain is never 
severe. 

4. Cough is present in over 90 per cent, of the cases. It 
comes on within 24 hours after the advent of the disease. At 
first it is short and "hacking" in character. Old people with 
pneumonia often have no cough. 

5. Expectoration is characteristic. In the first 48 hours of 
the disease it is simply frothy mucus. Then it becomes semi- 
transparent, viscid, gelatinous and tenacious, but never opaque. 
So tenacious is it that the cup containing it may be inverted 
without spilling the mass. This tenacity in great part causes 
the difficulty of expectoration. Its color varies. About the 



446 A COMPENDIUM OF PRACTICAL MEDICINE. 

second day the "brick -dust" or "rusty" sputa may be observed. 
This color is due to the presence of blood. The sputa may be 
creamy and yellow, or of a very dark or prune juice color; the 
latter occurs especially in alcoholic 1 subjects. Greenish sputa 
may occur in the middle of the disease and during resolution. 
When resolution occurs the sputum becomes abundant, and of a 
yellow creamy color. There may be no sputum throughout; or 
it may not appear until the sixth or even the twelfth day. The 
sputum may remain brick dust till the ninth or tenth day. In 
children sputa are usually absent. In senile pneumonia expecto- 
ration is never an early symptom. The sputa are rusty in about 
33 per cent, only of such cases; frothy or catarrhal sputa are the 
rule. A chocolate -looking serous sputum, appearing soon after 
the onset of pneumonia, shows a depraved condition and indi- 
cates "typhoid pneumonia." 

6. Temperature-range of a typical case of lobar pneu- 
monia indicates that it belongs to a remittent or sub-remittent 
type. The temperature rises suddenly during the initial chill, 
and in two or three hours after it may range from 102°tol05°F. 
After the first twenty-four hours the temperature is subject to 
morning and evening exacerbations and remissions. It is usually 
highest on the evening of the third day. A sudden rise of tem- 
perature may indicate a complication. The sudden fall of tem- 
perature on the fifth or sixth day indicates a crisis, and the 
beginning of convalescence. The fever may reach its highest 
point just before the crisis. Pneumonia is one of the few diseases 
terminating by crisis. When the temperature declines gradually 
("lysis"), a normal point is usually reached by the ninth day, 
sometimes not until the twelfth or fourteenth. A continuously 
high temperature after the tenth day indicates purulent infiltra- 
tion. Pneumonia at the apex has the highest tempeiature range. 
The fifth and seventh are the days of crisis in the majority of 
uncomplicated cases. Of 867 cases, 677 ended before the eighth 
day. 

7. Pulse varies with the severity, extent and stage of the 
pneumonia. In mild cases it ranges from 90 to 120; if it con- 
tinue above 120 the case is severe. The pulse is soft and full at 
the onset. Later it becomes small and feeble. It is not the most 



pnetjmostia. 447 

extensive pneumonia that is accompanied by the greatest flag- 
ging of the heart. Heart failure may exist before, or just as 
hepatization is commencing. "When the heart is failing the pulse 
shows that the artery is unequally filled by each beat. In chil- 
dren the pulse rate may be 200 per minute. 

8. The skin is often hot and dry until the crisis, but it may 
be bathed in perspiration from the onset. When the parched skin 
becomes moist at the acme of the disease and the patient is not 
relieved, it is an unfavorable symptom. 

9. Cowitenance. — In most cases the expression of the coun- 
tenance is characteristic. The face is anxious, and over the malar 
bones is a mahogany flush, not diffused as in typhus fever, but 
well defined and circumscribed. It is called the " pneumonic 
spot." The rest of the face is pale. Usually one cheek is more 
flushed than the other; this is due to disturbance of the vaso- 
motor system. The lips may be cyanosed, but at the crisis they 
become pale. 

10. Herpetic eruption upon the cheeks, nose, lips or eyelids 
occurs in about fifty per cent, of cases. It is rare before the sec- 
ond or third day and may not occur until the crisis. 

Sudamina may accompany profuse sweating. In children 
while the surface of the body is hot and dry, the extremities are 
cool and the pneumonic flush is bluish. Cyanosis of the extrem- 
ities is more frequent than in adults, and herpes IdbialAs is more 
constant. In old age the pneumonic flush is often the first ob- 
jective sign of pneumonia. The eye-lids alone are cyanotic. The 
face assumes a sallow hue and the surface heat is succeeded bv a 
cold, clammy perspiration. 

11. Cerebral symptoms are headache, slight delirium at 
night (it may be active), coma and convulsions in children. 

12. Digestive symptoms may be nausea and vomiting, 
anorexia and thirst. The tongue and lips may become brown, 
dry and cracked, and sordes collect on the teeth. The urine in 
pneumonia is scanty and high colored. Epistaxis is most fre- 
quent at the onset and at the crisis. Swelling of the veins of the 
hands in children is an unfavorable symptom. When pneumonia 
is to terminate fatally, dyspnoea increases, the patient "sinks," 
the pulse becomes small, rapid and intermittent, moist rales are 



448 A COMPENDIUM OF PRACTICAL MEDICINE. 

heard in the bronchi, the face is livid and the body is bathed in a 
profuse cold, clammy sweat. 

Abscess. — Acute pneumonia terminates in abscess in two per 
cent, of all cases. In these cases, the sputa are copious and fetid, 
yellowish in color, and consisting almost wholly of pus. The 
fever is of the hectic type, and is accompanied by rigors and 
sweats. Gangrene, as a termination of pneumonia, has been found 
in about 14 per cent, of cases. In these cases there is sudden 
collapse, rapid, feeble, intermittent pulse, face pale and death- 
like, and profuse expectoration of blackish -green masses. The 
breath is offensive and the body has a cadaverous smell. The 
sickening odor of pulmonary gangrene is most perceptible after 
coughing. Gangrene has its seat in the lower lobes of the lung. 

Purulent infiltration may be suspected when resolution 
does not take place at the period of crisis and the temperature 
remains high, accompanied by symptoms of prostration and 
profuse purulent expectoration. Death results from exhaustion. 

Typhoid pneumonia is a term that has been applied to a 
pneumonia attended by typhoid symptoms. There is no sputa, 
no dyspnoea, no pain, no cough. Sordes collect on the teeth and 
gums. The tongue is thickly coated, and later covered with 
thick black crusts. There is stupor, somnolence and continual 
low, muttering delirium. This form is common in the aged. 
Bilious, or gastric pneumonia, is lobar pneumonia occurring in 
malarial districts, accompanied by gastro- enteritis with hepatic 
symptoms. 

Physical Signs.—/. First Stage, or Stage of Congestion. — 
Inspection shows diminished respiratory movements on the af- 
fected side. Palpation shows increased vocal fremitus over the 
affected lung. Percussion shows slight dullness. Auscultation 
shows a feeble vesicular murmur. There is broncho-vesicular 
breathing. Within 24 to 36 hours there is heard with or at the 
end of inspiration a fine crackling sound over the inflamed region 
— the crepitant rale. This rale is highly diagnostic of pneumo- 
nia. It has been compared to the sound produced by rubbing a 
lock of hair between the fingers in front of the ear, and to the 
burning of grains of salt on live coals. As the sound is produced 
by the separation of the bronchioles and alveoli, adherent by the 



PNEUMONIA. 449 

viscidity of the albuminous exudation, it is obvious that it can 
occur only during inspiration. When consolidation takes place, 
the crepitant rale ceases. 

IT. Second, or Stage of Heel Hepatization. — Inspection 
shows lost respiratory movements of the affected side, and in- 
creased on the sound side. Palpation shows increased vocal 
fremitus. Percussion gives complete dullness. Auscultation 
gives bronchial respiration and bronchophony is heard over the 
whole of the consolidated lung. If the pleural cavity be partly 
filled with fluid, the voice sounds may be segophonic at the level 
of the fluid. Pectoriloquy may be heard (i. e., when the voice 
sounds directly into the ear from the chest). 

Ill Third, or Stage of Gray Hepatization. — Inspection 
shows returning respiratory movements. Palpation shows vocal 
fremitus gradually diminishing. Percussion shows diminishing 
dullness. Auscultation shows broncho -vesicular breathing, and 
rale redux (i. e., resolving subcrepitant rale). 

Differential Diagnosis. — Pneumonia may be confounded with 
pulmonary congestion and oedema, capillary bronchitis, pleurisy, 
hypostatic congestion, catarrhal pneumonia, pulmonary infarc- 
tion, meningitis and typhoid fever. 

Pneumonia commences with a chill, followed by a rapid rise 
in temperature and pain in the side. There is no chill, no fever, 
and no pain in pulmonary congestion and oedema. The expec- 
toration of pneumonia is viscid and rutsy; in pulmonary congest- 
ion and cedema, it is profuse, watery and blood-stained. As a 
rule, pneumonia is unilateral; pulmonary oedeina is bilateral. 
In capillary bronchitis there is heard all over the chest the sub- 
crepitant rale, the expectoration is niuco- purulent, the tempera- 
ture range is low, there is no dullness on percussion, no bronchial 
breathing, and cyanosis is marked. The breathing is labored in 
bronchitis, and panting in pneumonia. Acute plev/risy begins 
with chilliness, or several rigors, and low temperature; pneu- 
monia with a distinct chill followed by fever. In pleurisy tie 
face is pale and anxious, and the pulse is firm, small, tense, and 
wiry; in pneumonia the face has a mahogany flush, and the pulse 
is full and compressible. The breathing in pleurisy is catching; 
in pneumonia it is panting. In pleurisy there is a dry. hacking 



450 A COMPENDIUM OF PRACTICAL MEDICINE. 

cough with mucous expectoration; in pneumonia rusty sputum. 
In pleurisy with effusion, vocal fremitus is diminished, there is 
flatness on percussion, the respiratory sounds are feeble, and 
there is friction sound; in pneumonia vocal fremitus is increased, 
dullness on percussion, crepitant rales and bronchial breathing is 
present. In hypostatic congestion, the expectoration is copious, 
watery and blood-stained. It disappears when the patient sits up. 
Catarrhal or lobular pneumonia in children is usually secondary 
to bronchitis, is developed in both lungs, has no days of crisis, 
and no chill. Pulmonary infarction is rare without cardiac 
disease or pyaemia, is non febrile, and has intense dyspnoea. The 
expectoration is small black clots. Cases of pneumonia with 
cerebral symptoms may be mistaken for meningitis, but this can 
only happen should the chest not be examined. In meningitis 
there are no thoracic symptoms, no dyspnoea, and the face is pale 
and anxious. Pneumonia with typhoid symptoms is sometimes 
mistaken for typhoid fever. But the pneumonia which compli- 
cates typhoid fever does not come on until late in the fever, and 
the regular history of typhoid fever precedes its development 
(Bartholow and Loomis). 

Prognosis. — About twenty per cent, of cases of pneumonia die. 
The prognosis depends on the age of the patient. After sixty 
the prognosis is always unfavorable. Most "sudden deaths" in 
the old are from acute lobar pneumonia. Double pneumonia is 
rarely recovered from. Complications such as pleurisy, capillary 
bronchitis, and pericarditis render the prognosis unfavorable. 
The symptoms which are unfavorable are as follows: frequency 
and feebleness of the pulse; great frequency and labor of respira- 
tion; lividity of the prolabia and face; an abundant purulent 
or muco-purulent expectoration; prune- juice expectoration; 
active violent delirium; low muttering delirium with prostration 
and subsultus tendinum. The occurrence of purulent infiltra- 
tion, abscess, or gangrene renders the prognosis unfavorable 
(Bartholow and Loomis). 

Treatment. — Acute lobar pneumonia is a well defined, self- 
limited disease. It is thought to be a constitutional disease with 
a local lesion. Loomis says " The pneumonic lung no more re- 
quires treatment than the intestinal ulcers of typhoid fever. It is 



PNEUMONIA. 451 

the general condition of the patient not the local changes, which 
is to govern ns in the management of each case." If a patient be 
seen during the stage of congestion, Bartholow would apply five 
to ten f nil -sized leeches. Flint states that full doses of quinia, 
that is from 20 to 40 grains, given either at once or within eight 
or ten hours, may arrest the disease. Aconite is an effective sed- 
ative. Two to five drops of the tincture of aconite root may be 
given every two hours in the first stage. A large mustard poul- 
tice should be put on the chest, and removed when the skin is 
reddened, to obtain its stimulant effect on the vaso- motor nerves 
within, and the feet should be immersed in a hot mustard foot- 
bath. Bartholow states that modern researches have shown that 
calomel has a sedative action on the liver; lessens bile production 
and probably the whole functional activity of the liver; and as all 
cases of pneumonia are accompanied by hepatic disorders, it is 
clear that calomel is indicated. Calomel acts as an antipyretic and 
should be given on the first, second and third clays of the disease 
in doses of from three to five grains. When the exudation 
begins to coagulate a solution of the carbonate of ammonia (gr. 
v.-x.) in liquor ammonii acetatis (oss) every three or four hours 
is very useful. The Germans prefer the muriate in the same 
doses. The chest may be surrounded with cotton -batting or 
flannel jacket. Absolute rest is essential. The sick room should 
be well ventilated, and its temperature between 65° and 70° F. 
The diet should consist of milk, eggs, beef- tea, and concentrated 
broths. For the first four days Loomis would keep the patient 
under the full influence of opium by hypodermic injections of 
morphine. There are two sources of danger — heart failure and 
high temperature. Alcohol is the most efficient means for pre- 
venting heart failure. It is best to begin with small doses, when 
the pulse is frequent, feeble and irregular, and not more than 
six or eight ounces of brandy should be given in twenty-four 
hours. A dicrotic pulse, delirium, muscular tremor and collapse 
are indications for alcohol. 

To reduce the temperature there are two plans of treatment: 
the application of cold and internal antipyretics. Coldsponging 
may be practised when it is grateful to the patient. Of fche 
antipyretics, antipyrin and antifebrin are employed. Antifebrin 



452 A COMPENDIUM OF PRACTICAL MEDICINE. 

is to be preferred. In some cases of pneumonia quinine is more 
efficacious than antif ebrin in reducing fever, given in doses of gr. 
x-xx. every two hours. If there is restlessness or wakefulness in 
the third stage, chloral hydrate serves a most useful purpose. 
Fifteen grains at night is usually all that is required. To pro- 
mote the expectoration and to relieve the cough the proper reme- 
dies should be given. In weak subjects a little wine may be 
given from the beginning (Bartholow and Loomis). 

PRESCRIPTIONS FOR PNEUMONIA. 

j& Potassii iodidi 3j. 

Ammonii muriatis ^iss. 

Mist glycyrrhizse co 5yj. — M. 

Sig. : A tablespoonful four times a day, to promote absorption 
together with blisters to the chest. — DaCosta. 

{& Pulv, digitalis gr. vj. 

Quinige sulphatis gr. xij. 

Ext. opii 

Ext. ipecacuanha aa .gr. iij. — M. 

Ft. massa et in pil. no. xii. div. 
Sig. : One pill three times a day with the preceding mixture. 

— DaCosta. 

Jfc Ammonii carbonatis gr. xl. 

Infusi serpentarise , %iv. — M. 

Sig. : A teaspoonful every three hours. (As a stimulant about 
the crisis). — Bartholow. 

jfc Tinct. veratri viridis ZHxl. 

Spts. setheris nitrosi gvj. 

Liq. potassii citratis ^ivss. 

Syr. zingiberis ad gvj. — M. 

Sig. : A tablespoonful every three hours. (In early stage.) 

— DaCosta. 

Jfc Pulv. sinapis ^ss. 

Pulv. seminis lini Iviij. — M. 

Ft. cataplasma. 
Sig. : Apply to the chest covering with oiled silk. 

— J. Lewis Smith. 
Lobular Pneumonia. — Called also catarrhal or broncho -pneu- 
monia is always secondary, being preceded by inflammation and 
obstruction of the smaller bronchi, which lead to the consolidat- 
ed lobules (Loomis). 



PNEUMONIA. 458 

Causes. — It may be excited by an extension downward of 
a catarrhal process from the tubes to the air cells. It is most 
frequent between the ages of one and three, and in old age. The 
bronchitis of measles, whooping cough, influenza, etc., often 
leads to lobular pneumonia. Bad hygienic influences as to dress, 
habitations, humidity and exposure, favor its development (Bar- 
tholow and Loomis). 

Symptoms. — The beginning symptoms are chilliness, followed 
by fever, soreness of the chest beneath the sternum, cough, ex- 
pectoration of a frothy mucus and some difficulty of breathing. 
Soon the breathing becomes rapid, superficial and labored, and 
the alse of the nose work quickly and continuously. The face at 
first is flushed and rather animated, and the eyes have a glaring 
expression, but the lips soon become bluish and cyanosis spreads 
over the face. The cough, which during the preceding bron- 
chitis was loose, loud and bronchial, now becomes dry, hacking, 
and is usually very painful. The pulse ranges from 140 to 200 
per minute. The temperature will gradually rise to 104°- 105° F., 
unlike the sudden rise of lobar pneumonia. As the dyspnoea in- 
creases, there is increasing restlessness, never a moment of quiet, 
the struggle for breath and search for an easier position being 
incessant. The respirations are panting and may be 100 per 
minute. As the struggle for breath continues, the superficial 
veins grow into thick black cords, the result of carbonic acid 
poisoning, and the patient, a child, may tear the skin about the 
neck and face with its nails in a vain effort to remove supposed 
obstructions. The tongue becomes dry; sordes collect on the 
gums and teeth, and aphthous stomatitis is common (Bartholow 
and Loomis). 

Physical Signs. — Inspection shows a deep depression of the 
abdomen from retraction of the lower ribs on inspiration. Pal- 
pation shows increase of vocal fremitus when a considerable 
number of lobules have collapsed. Percussion shows no change 
until the atelectasis occurs, and then slight dullness. Ausculta- 
tion shows abundant rales all over the chest. They consist of 
subcrepitant rales which are somewhat coarser and louder than 
the crepitant, and are audible with both inspiration and expira- 
tion. There are also mucous and sub-mucous rales produced in 



454 A COMPENDIUM OF PRACTICAL MEDICINE. 

the larger tubes. There may be bronchophony (Bartholow and 
Loomis). 

Differential Diagnosis. — Catarrhal or lobular pneumonia may 
be mistaken for croupous pneumonia, bronchitis, acute tubercu- 
losis and oedema of the lungs. Croupous pneumonia is, as a 
rule, unilateral and limited to a certain area; catarrhal pneu- 
monia is bilateral and diffused over both lungs. The one is a 
self -limited disease, the other has no fixed duration. Capillary 
bronchitis may be primary; lobular pneumonia is always second- 
ary. The breathing is labored in capillary bronchitis and pant- 
ing in pneumonia. The one gives resonance on percussion, the 
other dullness. In acute tuberculosis the fever is higher than in 
pneumonia. Acute tuberculosis occurs in early adult life. Lob- 
ular pneumonia occurs oftenest in the child of one to four years. 
In oedema of the lungs there is no fever (Bartholow and Loomis). 

Prognosis. — Half the cases die. The average duration of 
acute lobular pneumonia is from ten to fourteen days (Bar- 
tholow and Loomis). 

Treatment. — To promote the expectoration Bartholow would 
give three to six grains of the carbonate of ammonia and four to 
eight grains of the iodide of ammonia in solution every two 
hours. Some authorities would give the muriate of ammonia. 
Oil of turpentine, eucalyptol and copaiba may be used for the 
same purpose. If there is excessive dyspnoea Bartholow would 
give two to three grains of the subsulphate of mercury to produce 
vomiting, and thus dislodge the muco-pus. For the high fever 
the same author would give two drops of tincture of aconite root, 
and one of tincture of belladonna, every two hours to a child of 
two years. For the continued high temperature three grains of 
quinine and one-fourth of a grain of digitalis can be given morn- 
ing, noon and evening to a child of two years. The patient 
should be kept in a warm room well ventilated. The air of the 
room may be filled with the vapor of oils of eucalyptus and tur- 
pentine, by heating them with water. The chest should be 
enveloped in linseed or mild mustard poultices, or in very young 
children a stimulating liniment may be rubbed on the chest two 
or three times a day and cotton -batting applied. The food 
should be fluid and nutritious. Stimulants must be given from 



PEIAPISM. 455 

the onset of the disease. Brandy or gin in milk, ten to twenty 
drops every three or four hours, may be given to a very young 
infant. If the disease is prolonged and emaciation is marked, 
cod -liver oil and the syrup of the iodide of iron should be given, 
with a change of air (Bartholowand Loomis). 

PRIAPISM. 

Is more or less continuous erection without desire. Inter- 
course with ejaculation may take place in some forms of priapism 
(Keyes). 

Causes. — Erection has long been observed to follow injuries 
to the cerebellum and spinal cord. Out of eleven cases of cere- 
bellar hemorrhage, erection of the penis was noted six times by 
Serres. Death by hanging is often accompanied by partial erec- 
tion. Erections are often absent after some diseases and injuries 
of the spine producing paraplegia; but in other cases the disease 
or injury is attended by priapism. Lallemand mentions the case 
of an officer who was thrown from his horse, and at once became 
paraplegic, and had priapism. As his paraplegia gradually got 
well his priapism ceased. The same author states the case of a 
soldier, who climbing out of garrison to see his mistress, fell 
upon his sacrum, and became partially paraplegic with priapism. 
As the priapism produced retention of urine, he attempted to free 
himself of it by masturbation, but without success. On one 
occasion, he indulged in copulation with his mistress almost con- 
tinously for several hours, until he had exhausted his partner — 
but all to no effect. He had no pleasure or ejaculation. 

Large doses of cantharides will produce erection without 
desire. Prolonged mental exertion, over-anxiety, etc., are some- 
times attended by priapism, due perhaps to some local injury, 
as gonorrhoea, the passage of a stone or a sound. Some prostatic 
affections are attended by priapism. Many writers mention 
leucocytlicemia as a cause of persistent priapism. Salzer gives as 
causes extravasation of blood in the corpora cavernosa, impeded 
circulation in the smaller vessels and the formation of thrombi. 
Mackie notes a case of persistent priapism lasting twenty- one 
days in an old man of seventy. After nineteen days the right 



456 A COMPENDIUM OF PRACTICAL MEDICINE. 

corpus cavernosum swelled and was relieved by incising it. He 
thinks that a small extravasation in the corpus cavernosum was 
the immediate cause of the priapism. Priapism in children is 
often due to stone in the bladder, tight prepuce, worms in the 
rectum, etc. (Keyes). 

Treatment. — Is hygienic and symptomatic. The lower part 
of the spine and peringeum may be blistered. Electricity, strych- 
nine, ergot and bromide of potassium may be tried. Iodide of 
potassium has been successfully used (Keyes). 

PRICKLY HEAT. 

Called also lichen tropicus because it is met with in tropical 
climates in its most typical form, is a congestion or slight inflam- 
mation at the orfices of the sudoriparous follicles (Anderson). 

Cause. — Heat is the exciting cause. 

Symptoms. — Little, bright red, acuminated papules, about 
the size of pinheads, make their appearance in great numbers, 
giving to the skin a rough feeling. They may be closely set to- 
gether, but generally remain discrete, the intervening skin having 
a healthy appearance. Here and there little A^esicles, such as are 
observed in sudamina, often make their appearance. This erup- 
tion is found chiefly upon the trunk and forehead, and is accom- 
panied by a tingling, pricking, or itching sensation. It is aggra- 
vated by the use of stimulating food and drink, as well as by 
heat and over -clothing. The rash frequently occurs in successive 
crops and the duration is indefinite (Anderson). 

Treatment. — Keep the patient cool. The skin may be fre- 
quently sponged with vinegar and water, or a weak lotion of 
carbolic acid followed by a soothing dusting powder, such as 
equal parts of oxide of zinc, lycopodium and starch. The diet 
should be very light and unstimulating. Saline aperients are 
useful, as well as diuretics and cooling acidulated drinks 
(Anderson). 

PROSTATITIS. 

Is an inflammation of the prostate gland. Congestion "of 
the prostate occurs physiologically during venereal excitement. 
If such excitement be unduly prolonged without being gratified, 



PROSTATITIS. 457 

or if the imagination be given up to erotic fancies, the mucous 
follicles of the organ secrete more or less of a peculiar, viscid, 
bluish mucus, without odor, which mixed with urethral mucus, 
finds its way out at the meatus. This is perfectly natural. It is 
analogous to the watering of the mouth of a hungry individual 
at the sight, smell, or even thought of food. This drop of mucus 
appearing during erection excites in the minds of many individ- 
uals whose sexual requirements are not met, the most lively 
alarm, and they hasten to consult a physician. Marriage, to 
place him in natural sexual relations, will effect a cure. If this 
physiological hyperseinia be kept up for a long time, the prostate 
is liable to remain congested, and cause frequent urination and a 
gleety discharge. Slight congestion of the prostate frequently 
complicates gonorrhoea and stricture, and it may pass on to actual 
inflammation. Congestion may be excited in the prostate by 
sexual excess and lead to prostatitis (Keyes). 

Causes. — Among the causes of parenchymatous prostatitis 
may be mentioned gonorrhoea, stricture, extreme and prolonged 
sexual excitement, acid urine, cold, injury, strong injections, and 
cantharides internally. Gonorrhceal inflammation after the first 
week, may run down the urethra and involve the prostate, if the 
patient indulge in alcohol, sexual intercourse, takes violent exer- 
cise, or uses strong injections deep in the canal. The inflamma- 
tion behind a stricture may run back to the prostate. 

Termination. — Prostatitis commences as congestion and passes 
on to true inflammation. It terminates by resolution with exu- 
dation of pus, by abscess, or it may linger indefinitely as a chronic 
inflammation (Keyes). 

Symptoms. — The prostate swells rapidly and often attains 
the size of an orange. The mass may be felt with the finger in 
the rectum, and is exceedingly sensitive to pressure, unlike hy- 
pertrophy of the prostate. In prostatitis, the finger in the rectum 
or pressure over the pubes brings on a desire to urinate. The 
patient is conscious of something protruding into the rectum. 
The perinseum feels hot and is sensitive to pressure. There is a 
feeling of weight and dragging in the pelvis, penis and scrotum. 
There may be pain in the back and limbs. The stream of urine 
is small and is passed with effort. The prostate may swell to 



458 A COMPENDIUM OF PRACTICAL MEDICINE. 

suet, an extent as to cause retention. There is a constantly 
recurring, never -satisfied desire to urinate. Voiding the urine 
causes pain, but the pain is most severe as the last drops are 
being expelled. The patient has fever, and is irritable, despond- 
ent and suspicious. Recovery is complete in from one to three 
weeks (Keyes). 

Treatment. — The main treatment is rest in bed with hips 
raised, some alkaline diluent for the urine, and enough anodyne 
to control severe pain. Rectal injections of hot water may be 
given. The patient may drink flaxseed- tea, infusion of triticum 
repens with some citrate of potash or Vichy water. If the pros- 
tatitis is due to gonorrhoea all active treatment and urethral injec- 
tions must be discontinued. Ten to fifteen leeches may be 
applied to the perinseum. Hot applications to the pelvis are 
useful. At night full doses of bromide of potassium with from 
gr. v.- xx. chloral hydrate maybe given to produce sleep (Keyes). 

PROSTATORRHCEA. 

Is also called follicular prostatitis. In this disease, the 
mucous surface of the sinus of the prostate and of the mucous 
follicles and ducts are inflamed, while the substance of the organ 
for the most part escapes. 

Symptoms. — It runs a chronic course. It may come on dur- 
ing gonorrhoea as the inflammation extends backward. The main 
feature of the disease is a slight oozing from the meatus of a 
muco- purulent matter. The discharge may be more profuse 
when at stool. The patient thinks the discharge to be semen. 
This discharge is exceedingly rebellious to treatment. If the 
prostatorrhoea, or follicular prostatitis, and the parenchymatous 
coexist, then a peculiar weight is felt in the perinaeum with pain. 
Walking becomes painful. Crossing the legs decidedly increases 
the pain, as does the sitting posture. There is frequency of 
urination. There is pain on passing water, which contains pus 
and blood. The pain may be felt at the end of the penis. The 
stream of urine is sometimes suddenly interrupted. The patient 
may be feverish and depressed. A slight gleety discharge accom- 
panies this condition (Keyes). 



PRURIGO. 459 

Treatment. — Xo remedy is so efficacious as blistering of the 
perinaeum. Cantharidal collodion may be painted on one side of 
the perinaeum, and the patient confined to bed for forty -eight 
hours, then the other side may be painted. Alkaline diluents 
may be given, and the bowels kept regular. A good diet and 
tonics are necessary. If this treatment fail, nitrate of silver (gr. 
v.-x. to the 5j.) may be injected into the membranous urethra 
(Keves). 

PRURIGO. 

Is a papular skin disease with intense itching. 

Causes. — Yerv little is known concerning its cause. The 
fact, however, that it is met with almost exclusively amongst the 
neglected children of the poor, seems to lead to the conclusion that 
defective diet and absence of proper hygienic surroundings are 
favorable to its occurrence (Anderson). 

Symptoms. — As a rule it begins in infancy, usually at first 
upon the legs in the form of wheals like those of nettle-rash. These 
come and go until the child is iive to seven years of age. At 
this time many solitary papules, about the size of hemp- seeds, 
make their appearance. They may be more readily felt than 
seen. The papules are irritable and soon become congested by 
scratching. The skin assumes a dusky tint and is covered with 
a fine mealy dust, and short stiff hairs. In some cases the skin 
feels as rough as a file and is thickened. The papules may sup- 
purate. The eruption is more severe upon the extensor sur- 
faces of the legs and arms than on the flexor surfaces. The trunk 
suffers some but the head, neck, scrotum, penis, palms and soles 
are usually free. Prwrigo is a most loathsome disease when fully 
developed. It is common in parts of Europe, but is rarely met 
with in England and America (Anderson). 

Prognosis. — Is very unfavorable. Hebra said that the 
patient may do whatever he pleases yet his malady will follow 
him to his grave (Anderson). 

Treatment. — The diet should be generous and the hygienic 
surroundings good. Tonics are indicated and a long continued 
course of arsenic in full doses. Carbolic acid internally thrice 
daily is beneficial. Local treatment is important. Warm, vapor 



460 A COMPENDIUM OF PRACTICAL MEDICINE. 

or Turkish baths should be ordered. A mixture of equal parts 
of soft soap, rectified spirit and oil of cade may be rubbed firmly 
into the skin in the morning and removed in the bath at bedtime, 
after which the following ointment may be applied: 

K S ulphuri? 

Glycerinae 

01 ei rusci aa 3 vi . 

Ung. rumicis 3ij-— M. 

Ft. ungt. 
Sig. : Apply locally. 

In some cases baths of corrosive sublimate, (5ij to the bath) 
are beneficial (Anderson). 

PRURITUS. 

Is a functional affection of the skin characterized by irrita- 
tion or itching and unaccompanied by eruption. Pruritus is a 
common affection. It may be continuous or intermittent, and is 
most complained of after getting warm in bed. It may involve 
the whole body, as we often see in old people whose health is 
failing; but more commonly it is localized, and the parts most 
liable to be attacked are the anus, the scrotum, and the labia 
(Anderson). 

Causes. — In any case, it is the result of direct or reflex irrita- 
tion of the cutaneous nervous filaments. Derangement of the 
digestive organs and constipation may cause it. Diseases of the 
kidneys, uterus and ovaries may produce it. It often results 
from impediment to the free return of venous blood from the 
part. It accompanies jaundice and results from the poisonous 
action of the bile acids, circulating with the blood, upon the 
nerves of the skin. A frequent source of pruritus is the presence 
of sugar in the urine, especially of that form which attacks the 
genital organs. Elderly women who have intense itching in and 
around the vulva, probably have glycosuria. Sometimes the 
cause of the pruritus disappears, while the itching continues 
owing to the cutaneous nervous filaments having contracted a bad 
habit. Finally, it may result from cold, and is then chiefly met 
with on the lower extremities (Anderson). 



PRURITUS PSORIASIS. 461 

Treatment. — Try to ascertain and remove the cause. If de- 
pendent on haemorrhoids, jaundice, diabetes niellitus, or digestive 
derangement, treat these morbid conditions. If the cause cannot 
be discovered, the treatment will be purely empirical, and in 
these cases it is desirable to have a good many strings to our bow 
since the affection is very obstinate. In such cases carbolic acid 
may be tried in the following formula: 

Be Acidi carbolici ^ij. 

Syrupi aurantii §j. 

Aquse %v. — M. 

Sig. : A teaspoonful in a glass of water three times daily on an 
empty stomach. 

Nerve tonics, as strychnine, phosphorus, and arsenic may be 
beneficial. Atropine may be tried as a nerve sedative. Dr. 
Eulkley, of New York, would give ten drops of the tincture of 
gelsemium every half hour till relief is obtained, or until one 
drachm is taken. If these remedies fail, bromide of potassium, 
sodium, or ammonium may be tried. Occasionally relief is ob- 
tained by sponging the surface with a warm decoction of poppy 
heads, or by the application of a weak continuous current of 
electricity. Alkaline baths may be tried (Anderson). 

PSORIASIS. 

Is a chronic eruption characterized by the appearance of 
dusky -red, or even coppery, slightly elevated patches of various 
sizes, covered with silvery -white, imbricated, and very adherent 
scales, with slight itching, but no exudation of the surface of 
the skin. 

Frequency. — It is by far the most frequent of the affections 
of the skin, except eczema and scabies. 

Parts Attacked. — The eruption may occar on any part of 
the body, but in the majority of cases it commences on the elbows 
or knees, and is frequeutly limited to these parts. Next to the 
elbows and knees the head is the part most commonly attacked 
(Anderson). 

Causes. — Are very obscure. Psoriasis is an hereditary dis- 
ease. Sir E. Wilson was of the opinion that psoriasia is "a 
manifestation of the syphilitic poison, after transmission through 



462 A COMPENDIUM OF PRACTICAL MEDICINE. 

at least one, and probably through several generations. " There 
is a non- syphilitic and a syphilitic form. Psoriasis may be in- 
duced by debility, but usually patients are in apparently good 
health. Long continued mental fatigue, as from over- study, 
great anxiety, etc., is very apt to call out the disease. It is met 
with in all ranks of life. Sea- air and sea -water are apt to call 
out an attack in one predisposed (Anderson). It is severest in 
the winter season. 

Symptoms. — As a rule, psoriasis does not occur before the 
sixth year, and usually comes out before the age of twenty -five. 
It is throughout a dry eruption. It is a non -febrile affection. 
The nails of the fingers and toes are sometimes affected and fall 
off. At the outset of the disease, little silvery- white scattered 
spots about the size of pin-heads make their appearance. As the 
disease advances, these spots may increase in size, being two to 
three inches in diameter. There is scarcely any itching. It is 
not contagious, but can often be traced to hereditary taint. The 
eruption may be on any part of the body, but almost always on 
the elbows and knees. Relapses are the rule. Psoriasis may 
last five, ten, fifteen, twenty or thirty years, or even a whole 
lifetime (Anderson). 

Prognosis. — The disease is not fatal, but relapses are 
common. 

Treatment. — The patient should take a course of baths, have 
plenty of fresh air, take his meals at regular hours, go to bed 
early, rise early, and have nothing to worry him. We should 
tone up the digestive powers. Nitro- muriatic acid and gentian 
often do good. Balsam of copaiba is occasionally of service. 
Tar and carbolic acid internally are often effectual. Liquor 
potassse in doses of from twenty to thirty drops thrice daily in 
water is highly praised. Acetate of potash in doses of one-half 
drachm thrice daily is beneficial. A course of carbonate of 
ammonia may be tried, also strychnia. Arsenic is the most 
valuable internal remedy which we possess in the treatment of 
psoriasis, and few cases resist it if given long enough. Five or 
six drops of Fowler's solution may be given thrice daily after 
meals. It agrees better with the stomach if given in bitter 
infusion — gentian. Next in value to arsenic comes cod-liver oil. 



PUERPERAL FEVER. 463 

The two may be combined. The syrup of the iodide of iron 
may be given also. Some cases are cured by a course of Bant- 
ingism — i. e., by a meat diet. The patient should be urged to 
eschew a too sedentary mode of life, to take open air exercise, 
and to try change of air and scene. Local treatment is of much 
value. Warm baths and soothing ointments may be used. Cold 
cream, cucumber ointment, the benzoated oxide of zinc ointment, 
ointment of carbonate or subacetate of lead, or a mixture of zinc 
and almond oil may be employed with advantage — three or four 
applications daily. The hydropathic treatment may be tried. 
Chrysophanic acid may be used in the form of an ointment, as 
follows : 

jfc Acidi chrysophanici gr. x. 

A dipis sj . 

Lanolini , , . . §j . — M. 

Sig. : Use locally night and morning. 

PUERPERAL FEVER, 

Is an infectious disease, due as a rule, to the septic inocula- 
tion of the wounds which resuult from the separation of the cle- 
cidua and the passage of the child through the genital canal in 
the act of parturition (Lusk). 

Frequency. — The total number of deaths to the entire num- 
ber of confinements is estimated to be in the proportion of 1 to 
85, or from puerperal fever alone in the proportion of 1 to 146 
(Lusk). 

Causes. — One source of puerperal fever is a contaminated 
atmosphere. Another and frequent source of puerperal fever is 
by direct inoculation. Any material of a septic character, in- 
troduced into the genital passages of a woman during or after 
confinement, may produce a general infection of the system. 
Pathogenic bacteria are invariably associated with puerperal 
fever, and to them the infectious qualities of the disease are due. 
Puerperal fever is really a surgical fever modified, however, by 
the peculiar physiological conditions which belong to the puer- 
peral state. It is a matter of ordinary experience that the reten- 
tion of a small bit of the membranes within the uterus will pro- 
duce fetid lochia, and as the result of infection, a febrile condi- 



464 A COMPENDIUM OF PRACTICAL MEDICINE. 

tion which as a rule, subsides with, the expulsion of the offend- 
ing body and the use of disinfectant washes (Lusk). 

Prevention. — The physician should insist upon the value of 
plenty of light and fresh air as a means of contributing to the 
speedy recovery of child- bed women, otherwise they may become 
poisoned with their own exhalations. Complete antisepsis be- 
fore confinement will prevent the introduction of germs and after 
confinement will paralyze their action. Employ means to pro- 
mote uterine contraction. Refrain from attending a case of labor 
when fresh from the presence of contagious diseases or septic 
material. In every case of labor the hands and forearms should 
be freely bathed in a carbolic solution before making a vaginal 
examination. All instruments employed during confinement 
should be disinfected. The warm carbolized douche after deliv- 
ery stimulates uterine retraction and promotes the rapid healing 
of wounds in the vaginal canal. The fountain syringe should be 
used (Lusk). 

Symptoms. — The first febrile symptoms usually occur within 
three days of the birth of the child. The third day is the one 
upon which, ordinarily, the beginning of the fever is to be antici- 
pated. After the fifth day an attack is rare. In most cases the 
fever is ushered in by chilly sensations, or by a well-defined chill. 
A frequent pulse is always a suspicious symptom in childbed, 
even where the other symptoms are apparently normal. There 
may be headache, sleeplessness, pain, vomiting, anorexia, and 
coated tongue (Lusk). 

Treatment. — It is to be recommended that in every case of 
puerperal fever, the vagina be cleansed with a two to three per 
cent, solution of carbolic acid, or corrosive sublimate (1:3,000) 
every four to six hours. The douche in itself is absolutely harm- 
less. No portion of the injected fluid should be retained in the 
vagina. All necrotic patches of the vagina or cervix should be 
touched with hydrochloric acid, or with a ten per cent, solution 
of carbolic acid, or with iodoform. Intra-uterine injections 
should be resorted to with extreme circumspection. Rarely are 
they indicated. Opium must be given for the pain. Purgatives 
(castor- oil in two or three tablespoonful doses) should be ad- 
ministered with caution. For the fever quinia may be adminis- 



PUKPUPA. 465 

tered in five grain doses at intervals of fonr to six honrs. Stimu- 
lants in the form of whiskey, rum, or brandy may be given in 
doses of one or two teaspoonfuls hourly. Ice-cold drinks should 
be freely allowed (Lusk). 

PURPURA. 

Is a general disease, characterized by circumscribed extra- 
vasations of blood into the skin (Loomis). Purpura may be 
simple, rheumatic, hemorrhagic, or symptomatic. In simple pur- 
pura there are only minute extravasations into the skin (petechia) ; 
in rheumatic purpura there is a combination of purpura and 
rheumatic pains in the joints; in hemorrhagic purpura there is 
great constitutional disturbance, petechia not only appear in 
the skin, but ecchymoses, and there may be hemorrhage from all 
the mucous tracts; in symptomatic purpura, the purpuric spots 
accompany the exanthems and contagious fevers, and are purely 
symptomatic (Bartholow, Loomis and Flint). 

Morbid Anatomy. — There are changes in the walls of the 
vessels, or in the blood, or in both (Loomis). 

Causes. — Purpura occurs more frequently in women than in 
men. It may appear in the healthy and robust. The leading 
causes are bites of insects, passive congestion, various drugs, such 
as iodide of potassium, phosphorus, copaiba, ergot, chloral, and 
mercury; snake -bites, embolism and thrombosis of cutaneous 
vessels, cachexia, as tuberculosis, cancer, Brighfs disease, cirrhosis 
of the liver, anaemia, leucocythsenria; diseases of the nervous 
system, small -pox, typhus and typhoid fevers, measels, scarlet 
fever, malaria, cholera, yellow fever, cerebro- spinal meningitis, 
icterus, scorbutus, etc. Purpura may be accidentally present in 
the course of any disease (Flint). 

Symptoms, — In many cases for days before the eruption 
appears, there is a feeling of malaise with digestive derangement. 
Purpuric spots are bright-red, livid, or dark purplish -red in color, 
they do not disappear on pressure, and are unattended by itching 
or other signs of local irritation. As a rule the spots are not 
elevated. They vary in size from a pin's head to a large pea, or 
a spot may measure an inch in circumference, and change in color 



466 A COMPENDIUM OF PEACTICAL MEDICINE. 

successively from bluish-red to greenish brown, and yellow. It 
is more common from fifteen to twenty than at any other age. 
In ordinary cases a crop of purpuric spots lasts from a week to 
ten days, and usually first apppear on the legs. Purpura is 
common in fruit seasons (Bartholow, Da Costa and Flint). 

Differential Diagnosis. — Purpura may be confounded with 
scurvy and shin diseases. From scurvy it is distinguished by the 
absence of spongy gums and painful swellings. The fact that 
there is no itching, no desquamation, no suppuration or discharge, 
and no change in purpuric spots upon pressure suffices to dis- 
tinguish them from the eruption of any form of skin disease 
(Loomis). 

Prognosis. — Most cases terminate in recovery. 

Treatment. — The diet should be nutritious and varied, and 
digestion is to be aided by tonic remedies, together with wine or 
spirits in small quantities. Dilute sulphuric acid may be given 
in doses of from five to fifteen drops every two hours combined 
with quinia. Ergot, gallic acid, and tincture of the chloride of 
iron may be of service (Flint). 

PYEMIA. 

Is an infectious disease, characterized by the formation of 
infarctions, metastatic abscesses and diffuse local inflammation. 
Venous thrombosis and embolism are essential features of this 
disease, and cause metastatic abscesses in the lungs, liver, 
kidneys, spleen, muscles, heart and brain. Metastatic abscesses 
vary in size from a pea to a large walnut (Loomis). 

Causes. — Many regard the pyaemic and septicaeniic poison as 
identical, and pyaemia as nothing but a metatistic septicaemia. 
Inflammation of bone is a very frequent cause of a phlebitis 
which leads to pyaemic infection. Cellulitis, carbuncle, erysipe- 
las, malignant pustule, and dissecting wounds are often compli- 
cated by pyaemia. Endometritis or lacerations about the genital 
tract are fruitful sources of pyaemia in the puerperal state 
(Loomis). 

Symptoms. — Pyaemia is ushered in by a distinct chill or rigor 
followed by a gradual rise of temperature to 101° or 104° F. The 



PYJEMIA PYROSIS. 467 

chills of pyaemia occur irregularly, aud are followed, after the 
first two or three, by profuse and exhausting sweats. The pulse 
is frequent, 120 to 140, small and often intermittent. The skin 
may be jaundiced. The breath has a peculiarly sweet, sickish 
odor. The tongue becomes coated, glazed, dry, brown and fis- 
sured. Sordes collect on the teeth. There are anorexia and 
great thirst. There is usually diarrhoea with nausea and vomit- 
ing (Loomis). 

Differential Diagnosis. — The diagnostic points of pysemia are, 
irregularly recurring chills and sweats, great variations in tem- 
perature, with the signs of multiple abscess in the internal 
organs. . Pyaemia may be confounded with septicaemia, intermit- 
tent fever, acute yellow atrophy of the liver, acute articular 
rheumatism, typhus and typhoid fever. 

Pyaemia is ushered in by a distinct chill; septicaemia by 
slight shivering, or mild rigors only. In pyaemia the chills recur; 
in septicaemia there is but one chill. In pyaemia there are 
profuse sweats which recur; in septicaemia, they are slight and 
never recur. In pyaemia the temperature gradually rises to 
102° to 104° F.; in septicaemia it is high at the onset, 105° to 
1 07° F. In pyaemia the skin is jaundiced; not so in septicaemia. 
There is a sweet, sickish odor to the breath in pyaemia, absent 
in septicaemia. In pyaemia multiple abscesses develop, never in 
septicaemia (Loomis). 

Prognosis. — Is always unfavorable. 

Treatment. — Cleanliness, good ventilation, sunlight and quiet 
are important measures. Quinia, carbolic acid, salicylic acid 
and oil of turpentine may be used internally. A good diet and 
stimulants should be administered in large quantities (Loomis). 

PYROSIS. 

The regurgitation of a considerable quantity of a liquid 
which is either insipid or saltish or brackish and is sometimes 
acid when the stomach is empty of food and usually in the morn- 
ing is called pyrosis or waterbrash. This liquid consists mainly 
of saliva. Sometimes there is not only a feeling of oppression in 
the thorax but a severe pain is referred to the heart accompanied 



468 A COMPENDIUM OF PRACTICAL MEDICINE. 

by palpitation and dyspnoea. In such cases the patient is very 
apt to imagine he has heart disease. Pyrosis is not a disease but 
a symptom of certain cases of gastric dyspepsia (Flint and 
Loomis). 

PARAPHIMOSIS. 

Exists where the prepuce gets behind the corona glandis 
and cannot be replaced (Keyes). 

Causes. — An unnaturally tight preputial orifice is a predis- 
posing cause. Young boys who retract the prepuce for the first 
time often find themselves unable to replace it. Rings of metal 
forced upon the penis retracting the prepuce may be a cause. 
Inflammatory paraphimosis may depend upon balanitis, gon- 
orrhoea, herpes, chancroid, chancre, etc. (Keyes). 

Symptoms. — In paraphimosis the glans penis is swollen and 
livid. If the patient is seen at once, there may be no inflamma- 
tion, either of the prepuce or the glans. If the stricture of the 
prepuce is tight enough to arrest the circulation it will cause 
gangrene (Keyes). 

Treatment. — /. Of paraphimosis with strangulation. In 
strangulation the glans penis is turgid, swollen, blue-black, cold 
and devoid of sensibility. Ice should be first used locally to 
produce shrinkage and a few small punctures may be made to 
let out serum from the ridge in front of the stricture. In these 
cases ether should always be given to relax the tissues and reduc- 
tion attempted. If a prolonged, careful attempt at reduction 
fails, the strictured point must be divided. After reduction the 
treatment consists in position, rest and cleanliness, syringing the 
preputial cavity with warm water. 

II. Of paraphimosis without strangulation. — In recent 
cases reduction must be effected or inflammation will surely set 
in. Reduction may be accomplished by using the above means 
(Keyes). 

PHIMOSIS. 

Exists where the orifice of the prepuce is so small that the 
glans penis can not be uncovered. Phimosis is congenital or 
acquired, simple or inflammatory, complicated by other diseases, 



phimosis. 469 

or by adhesions. With very young children, phimosis is so 
common that it may be considered normal. The foreskin of a 
child is developed out of all proportion to the rest of the j^enis. 
This long prepuce is often a source of anxiety to young mothers. 
A positive indication for operation, in the case of a child, does 
exist, where the preputial orifice is smaller than that of the 
urethra. This condition is known to exist when the prepuce 
"balloons" during micturition. When the prepuce is too tight 
in the adult, an operation may be called for as a prophylactic 
against future disease, such as chancre, chancroid, gonorrhoea, or 
an attack of herpes (Keyes). 

Causes. — Phimosis may be caused by frequent attacks of 
preputial inflammation, leaving a thick, long, indurated, inelastic 
prepuce, interfering not only with sexual intercourse, but some- 
times with urination. Another common cause of acquired phi- 
mosis is the cicatrization of multiple chancroid around the orifice 
of the prepuce. Diabetes is said to be a cause of phimosis. 
Marx reported a case of phimosis where a passionate and jealous 
woman made her lover wear a gold padlock (sometimes two) 
with which she secured the preputial orifice, keeping the key 
herself. The victim of her charms carried his padlocks, which 
were replaced from time to time through new punctures, during 
four or five years, until such a degree of irritation had been set 
up as to require removal of the prepuce. Inflammatory phimosis 
is a transient condition, but may leave true phimosis behind 
(Keyes). 

Treatment. — It is better not to circumcise when the prepuce 
is inflamed, if it can be avoided. Keep the patient in bed, and 
elevate the penis. Evaporating lotions may be used locally, con- 
taining a little spirit or a (gr. x.-xx.) solution of tannin, fre- 
quently washing out the cavity of the prepuce by means of a 
syringe with dilute lead- water or carbolic acid (gr. ij. to the gj.). 

Remote Results of Phimosis. — It leads to imperfect develop- 
ment of the glans penis, is an obstacle to sexual intercourse, 
causes spermatorrhoea, frequent desire to urinate and cystitis. 
According to Dr. Sayre, of New York, phimosis may cause 
curvature of the spine in children, and priapism (Keyes). 



470 A COMPENDIUM OF PRACTICAL MEDICINE. 

PTERYGIUM. 

Is a triangular thickening of the conjunctiva, which ad- 
vances from the caruncle to the cornea and encroaches more or 
less upon the surface. The favorite site is the inner side of the 
eyeball. The structure grows very slowly. It may impair sight 
before it reaches the pupilary area. The apex is more or less 
rounded and seems to dip into the substance of the cornea. The 
edges near the apex will be found to be rolled under and will 
admit a fine probe to be thrust beneath for a short distance. It 
appears mostly in persons who are exposed much to the weather, 
or to dust, and who are of advanced age. A variety of fleshy 
ptergium may occur at any portion of the eye (Noyes). 

Treatment.- — Is surgical and preferably by excision. Seize 
the corneal portion with toothed forceps and as it is lifted, push 
beneath it a cataract knife and shave it from the cornea. Cut 
away as much of the base as may be needful. The raw surface 
may be covered by flaps of the adjacent conjunctiva sutured by 
silk. Cocaine will annul the pain. An opacity of the cornea is 
left, which will continue for months. It may ultimately dis- 
appear (Noyes). 

PYELITIS. 

Is an inflammation of the mucous membrane of the pelvis of 
the kidney. There is hyperemia of the mucous membrane, and 
exudation of pus and mucous takes place. In many cases with 
profuse production of pus there is an obstacle to the passage of 
the urine, and the pus is retained in the dilated pelvis, causing the 
condition known ^pyonephrosis (Flint). 

Causes. — Pyelitis is seldom, if ever, a primary disease. Its 
most frequent cause is the presence of calculi in the pelvis of the 
kidney. Obstruction to the flow of urine is a cause of pyelitis. 
Such obstructions are furnished by calculi, tumors pressing on 
the ureter, enlarged prostate, stricture of the urethra, phimosis, 
and paralysis of the bladder in cases of paraplegia. In these 
cases the urine is retained and decomposes, and thus produces 
irritation. The pressure of a retroverted or pregnant uterus may 
cause obstruction to the flow of urine. Pyelitis may be due to 



PYELITIS. 471 

gonorrhoea, specific vaginitis, and urethritis in females. In these 
cases cystitis is nearly always present. Copaiba, turpentine, and 
cantharides passing through the kidneys may cause pyelitis. 
Pyelitis may be a complication in pyaemia, puerperal fever and 
the exanthemata (Bartholow, Flint and Loomis). 

Symptoms. — Pain in the back is present in the mild as well 
as in the severe cases. This pain, as a rule, is severest over one 
or both lumbar regions, is often of an aching character, and 
shoots down along the course of the ureters. The voiding of 
urine is almost incessant, and is attended by severe pain. Acute 
pyelitis is usually ushered in with rigors. Symptoms of hectic 
fever may also mark the occurrence of permanent obstruction of 
the ureter and the development of that condition termed pyone 
phrosis, There is lassitude and more or less pain on motion. 
There are changes in the urine. In its early stage the urine 
contains blood mixed with mucus and epithelium cells from the 
pelvis of the kidney. The presence of these epithelial cells is 
its most certain diagnostic indication. The specific gravity of the 
urine ranges from 1025 to 1030, and usually has an acid reac- 
tion. The urine may be ammoniacal. Calculous pyelitis is 
attended with more pain and hemorrhage than the other forms. 
In the advanced stage of pyelitis, the discharge of pus is con- 
stant, but if the ureter becomes blocked, for a time the urine 
may be quite normal, but the removal of the obstruction is fol- 
lowed by a copious flow of purulent urine. If there be perma- 
nent obstruction in the ureter, a tumor develops in the lumbar 
region. The existence of the tumor is determined by the pres- 
ence of bulging between the crest of the ilium and the false ribs 
on the side involved. Palpation shows deep-seated fluctuation 
over the tumor and tenderness on pressure. Percussion shows 
dullness over the tumor. A hypodermic needle will complete 
the diagnosis (Bartholow, Flint and Loomis). 

Differential Diagnosis. — The diagnosis of pyelitis in the acute 
stage rests mainly on the presence of the characteristic epithe- 
lium of the pelvis mixed with blood and mucus. In a more 
advanced stage, in addition to the above, there is pus. The 
presence of pus and acid urine, with pain in the lumbar region, 
accompanied by the development of a tumor at the seat of pain. 



472 A COMPENDIUM OF PRACTICAL MEDICINE. 

which tumor gradually increases in size and suddenly disappears 
at the same time that a copious discharge of pus takes place from 
the bladder, which discharge is attended by a sense of great 
relief to the patient, renders the diagnosis of pyonephrosis very 
certain. 

Pyonephrosis may be confounded with hydronephrosis, 
hydatid cyst and perinephritic abscess. Hydronephrosis is dis- 
tinguished fi 'om pyonephrosis by the non- purulent character of 
the urine, and by the absence of constitutional symptoms. An 
aspirating needle will generally decide the diagnosis. In 
perinephritic abscess neither pus, blood, mucus, epithelia nor al- 
bumen will be found in the urine; in pyonephrosis they are 
common and constant. Pain on motion and fever are marked 
symptoms in abscess and slight or absent in pyonephrosis. In 
women a pyonephrotic tumor has been confounded with an 
ovarian cyst. The exploring trocar will very quickly remove all 
doubts. Pyelitis is distinguished from cystitis by the absence 
of vesical pain and frequent micturition and by lumbar pain. In 
pyelitis the urine is acid; in cystitis it is alkaline (Loomis). 

Prognosis, — Depends much on its causes. 

Treatment. — Remove the cause if possible. In acute pyelitis 
if there be fever, pain, and bloody urine, wet cups should be ap- 
plied to the loins followed by a hot bath and a hypodermic of 
morphine to relieve pain. Alkaline drinks should be given and 
the patient kept in bed. If the urine is acid, liq. potassii citratis 
should be given. In ammoniacal urine benzoic acid is extremely 
serviceable. In chronic pyelitis, eucalyptol, oils of turpentine, 
copaiba and cubeb limit the formation of pus. Cod-liver oil and 
quinine should be given with a nutritious and non -stimulating 
diet. Alkaline mineral water and milk should be freely given. 
If a tumor exist aspiration may be performed (Bartholow and 
Loomis). 

PICA AND MALACIA. 

Are terms applied to perversions of appetite. Malacia de- 
notes a morbid craving for certain articles of food, whereas pica 
denotes a desire for innutritious substances. The craving for 
strange kinds of food during pregnancy and in hysterical women 



PICA AXD MALACIA POLYPHAGIA. 473 

is familiar to all. The innutritious substances frequently craved 
are charcoal, chalk, slate, and certain kinds of earth. In some 
cases of pica the articles are at first taken with the idea of im- 
proving the complexion and in this way the habit is formed; but 
in other cases a morbid uneasiness in the stomach leads to their 
use. This appetite is chiefly confined to young females and is 
generally associated with anaemia or chlorosis. 

Treatment. — Treat the associated disorders and prohibit the 
use of the above substances (Flint). 

POLYPHAGIA. 

Called also bulimia denotes a craving for food beyond the 
wants of the system. These terms are not correctly applied to 
the increased appetite during convalescence from fevers or other 
acute diseases. In true bulimia the amount of food craved far 
exceeds the requirements for nutrition. Bulimia may be another 
name for gluttony. The love of eating may be cultivated to such 
an extent that little else is thought of, and persons who fall into 
this habit may be said to live to eat, rather than to eat to live. 
Habits of gluttony may lead to dyspepsia, obesity, fatty degen- 
eration of the heart and to various affections. Bulimia may be 
a symptom of mental disease, or of diabetes. Cases have been 
reported in which the morbid appetite appeared to be insatiable, 
all kinds of food — raw meat, candles etc., — being eaten in some 
cases with avidity and in enormous quantity (Flint). 

Treatment. — Recovery from this condition is to be expected. 
The indications are to regulate the diet, to establish the general 
health, to correct any disorder of digestion, and to palliate the 
excessive craving for food by oj)iuin, or sometimes by nauseant 
remedies. Swallowing pieces of ice has been found effective as 
a palliative measure (Flint). 

PARALYSIS AGITANS. 

Sometimes called Parkinson's disease, or shaking palsy, or 
the trembles, is a disease of advanced life characterized by motor 
weakness and tremors of the voluntary muscles, especially of the 
limbs, occurring independently of muscular exertion (Loomis). 



474 A COMPENDIUM OF PRACTICAL MEDICINE. 

Morbid Anatomy. — Paralysis agitans is a neurosis, a func- 
tional disorder. As yet no constant changes have been dis- 
covered. Some authorities consider it of spinal, others of cere- 
bral origin (Bartholow and Loomis). 

Causes, — It rarely occurs before forty, and is more common 
in men than women. It is not known to be hereditary. The 
principal causes are strong emotion, fright, grief, anxiety, dis- 
tress of mind, great bodily fatigue, and exposure to cold and 
dampness (Bartholow and Loomis). 

Symptoms. — Tremor is the chief symptom of paralysis agi- 
tans. The trembling consists of fine small movements. Paraly- 
sis agitans comes on slowly, and progresses slowly. It usually 
begins in one foot, hand or possibly a single finger, and gradu- 
ally becomes general. The tremors are often confined to one 
side of the body for a long time— hemiplegic type; less fre- 
quently to both lower extremities — paraplegic type. Any effort 
of the will, as grasping, writing, or walking, will stop the irreg- 
ular motions. Sometimes the disease sets in abruptly in conse- 
quence of some sudden shock. Mental emotion and exercise in- 
crease the trembling, and sleep and chloroform narcosis suspend 
it. The trembling consists in muscular contractions and relaxa- 
tions. The hands are apt to assume a position as in writing. 
As a rule, the bead and neck are not affected. The countenance 
assumes a fixed, staring look of distress, the head is drawn for- 
ward and the trunk fiexed. The voice is often tremulous and 
speech is slow, hesitating and laborious. The muscles are easily 
tired. The patient rises slowly and is deliberate in starting, but 
when under way, he goes in a dog-trot with the head and body 
bent forward (festination). Complaints are made of cramps, of 
muscular stiffness, of a sense of excessive heat, and of restless- 
ness. The knee-jerk is normal (Bartholow, DaCosta, Flint and 
Loomis). 

Prognosis. — Although the disease may last for twenty or 
thirty years, death most commonly results from some intercur- 
rent disease. The outlook is never favorable (Loomis). 

Differential Diagnosis. — Paralysis agitans may be confounded 
with disseminated sclerosis, senile trembling, alcoholic, lead and 
mercurial trembling. In disseminated sclerosis tremors occur 



RACHITIS. 475 

only when the muscles are m use; the disease begins in the lower 
limbs, affects younger persons, and paralysis occurs early. The 
patient has no tendency to run forward and does not have the 
peculiar countenance. In paralysis agitans the tremor is not 
dependent on volition; it begins in the upper limbs, and per- 
sons under forty years are exempt from this affection. Paralysis 
occurs late. The patient has a tendency to run forward and has 
a fixed, staring countenance. In senile trembling the head is 
chiefly affected and there is no paresis of muscles, no stiffness, no 
deformity of the extremities, and no impulse to run forward. 
Alcoholic, lead and mercurial trembling are readily diagnosti- 
cated by the previous history (Bartholow, Flint and Loomis). 

Treatment. — No plan of treatment is satisfactory. Hyoscy- 
amine, according to Charcot, is the best remedy to moderate the 
trembling. Gelsemium is useful. The chloride of gold and so- 
dium, corrosive sublimate in small doses, nitrate of silver, and 
the lactophosphate of lime with arsenic may be tried. The gal- 
vanic current may be tried (Bartholow and Loomis). 

RACHITIS. 

Called also rickets, rachitismus and osteomalacia, is a con- 
stitutional disease of the first years of life, characterized by a 
disorder of nutrition in which the growth of the bones is irregu- 
lar, calcification imperfect, and deformities ensue (Bartholow). 

Causes. — Rickets is a common result of faulty diet and of 
anti-hygienic surroundings, and is therefore frequent among the 
poor of cities, and especially in families who dwell in crowded 
tenement -houses. It is more common in the great cities of 
England and Europe than in this country. Acute disease and 
troublesome dentition predispose to it. It is more apt to occur 
in children of rachitic, syphilitic or phthisical parents. The off- 
spring of consanguinious marriages, of those too old, or of the 
feeble and cachectic, are, as a rule, rickety. The rickety consti- 
tution may also be inherited. Of the exciting causes, the most 
common is the use of food not sufficiently nutritive, or, if nutri- 
tious, not suited to the age and digestive powers of the child. 
Thin and poor breast-milk and artificial food of poor quality arc 



476 A COMPENDIUM OF PRACTICAL MEDICINE. 

common causes of rickets. The presence of lactic acid in the 
intestinal canal of the infant may produce rickets according to 
some authorities. The disease is rare before the fourth and after 
the seventh year of life. Children of well-to-do families are also 
liable to rickets (Bartholow, Loomis and J. L. Smith). 

Symptoms. — Usually gastro- intestinal disturbances are the 
earliest symptoms of rickets. There may be vomiting, and the 
stools are frequent, pasty and offensive. The stools are light in 
color, because of the absence of bile, and have an acid reaction. 
The appetite is poor. The child wastes and grows dull, listless 
and peevish. Pains about the joints are complained of. The 
anterior fontanelle remains open. 

Profuse perspirations of the head, neck, and upper part of 
the chest, appear chiefly while the child is asleep, but at the same 
time the abdomen and extremities are dry and hot. The child 
kicks off the covers from its legs. There seems to be tenderness 
of the whole body, and the rickety child cries out when it is 
taken up, or moved, or pressed on. It is languid, its counten- 
ance wearied, depressed, and aged, the face grows broad and 
square, the hair is thin, dry, and dead, the muscles are wasted, 
and flabby, the head sinks between the shoulders, and the abdo- 
men is swollen and protuberant. Now the extremities of the long 
bones swell and have a knobby appearance, and the bone bends 
readily. The child may be knock-kneed, or have bow-legs. 
Curvature of the spine also takes place. The lower jaw is short- 
ened, so that the upper teeth overlap the lower. The teeth appear 
late. Rachitic children are usually pigeon-hreasted, and there is 
often marked deformity of the pelvis. The ribs, being softened, 
yield to the atmospheric pressure, thus projecting the sternum 
forward. The head of a rickety child appears larger than that of 
a healthy child of the same age, is flat on top, and the forehead 
is large and square. The limbs of the child are short in propor- 
tion to the trunk. Rachitic children are anaemic and very sensi- 
tive to changes of temperature. As the osseous changes go on 
emaciation goes on at the same rate, the abdomen enlarges still 
more, the muscles waste and grow weaker, there is less and less 
disposition to voluntary exertion, the perspirations aremorefree, 
the thirst increases, the bowels become more deranged, thejstools 



RACHITIS. 477 

fetid, and the food passes unchanged. All rickety children do not 
emaciate. Persons who were rachitic in infancy frequently be- 
come very strong as they reach adult life (Bartholow, Loomis 
and J. L. Smith), 

Differential Diagnosis. — The only disease with which rickets 
in its early stage may be confounded is inherited syphilis. 
Rickets does not appear, as does syphilis, during the first days 
of life. The "snuffles 11 and cutaneous lesions do not belong to 
rickets; the sweats about the head, the osseous changes, the 
enlargement of the spleen and liver, the weakuess of the legs, 
the rims around the cranial bones, the large, lax joints, and the 
gastro- intestinal disturbances are symptoms of rickets which dis- 
tinguish it from any other disease (Bartholow and Loomis). 

Prognosis. — Is usually favorable, provided no serious com- 
plication arises. The complications of rickets are bronchitis, 
pneumonia, enteritis, laryngismus stridulus, convulsions, difficult 
dentition, diarrhoea, and chronic hydrocephalus (Loomis). 

Treatment. — Good air, warm clothing, daily bathing, and a 
nutritious diet are essential. Children kept too long at the 
breast often become rickety, and should be weaned at once. 
Good cow's milk, diluted by one-third to one-fourth of lime- 
water is the most suitable aliment. Scraped raw beef, with a 
small amount of wine, often produces marked improvement. 
Pepsin with bismuth may be given for the vomiting and diar- 
rhoea. Pepsin with diluted muriatic acid is also useful. Cod- 
liver oil should be taken as early and in as large doses as the 
child can digest. Beef tea may be given. Rachitic children 
should not sleep on feather beds or high pillows. The perspira- 
tions may be relieved by sponging with vinegar and water. The 
following formula will be found useful in most cases: 

Jfc Olei morrhuse 5iv. 

Aquas calcis 

Syrupi calcis lactophosphatis — aa5ij. — M. 

Of this, one teaspoonful should be given four or five times 
daily to an infant of one year (Bartholow, Loomis and J. L. 
Smith). 



478 A COMPENDIUM OF PRACTICAL MEDICINE. 

RHEUMATISM. 

Is a constitutional disease characterized by certain local 
manifestations seated in the articulations and the fibrous tissues 
in other parts (Flint). 

Varieties. — I. Acute articular rheumatism. II. Sub-acute 
articular rheumatism. III. Chronic articular rheumatism. IV. 
Arthritis deformans. V. Muscular rheumatism, " Myalgia " 
(Loomis). Acute articular rheumatism frequently called rheu- 
matic fever and ,p.ol/y arthritis rheumatica is the variety charac- 
terized by fever, inflammation of the joints occurring in succes- 
sion and by a tendency to attack the peri- and endocardium. 

Causes. — It is more frequent in men than in women because 
men are more exposed to the influences producing it. Protracted 
stay in damp apartments, lying between damp sheets all night, 
exposure of the body to cold and wet, when in a heated and per- 
spiring state act only as an exciting cause. A special predisposi- 
tion is requisite. This predisposition or diathesis may be con- 
genital and inherited or it maybe acquired. There is an hered- 
itary tendency in about thirty per cent, of cases. It occurs 
mostly between fifteen and thirty years of age. It is rare in old 
age. The seasons of greatest prevalence are winter and spring. 
Some claim that an excess of sulphur or lactic acid in the blood 
will produce rheumatism if the vice of constitution exists. Erysip- 
elas, dysentery, scarlatina, gonorrhoea, syphilis, pregnancy, scrof- 
ula, phthisis and cancerous affections seem to act as exciting 
causes (Bartholow, Flint and Loomis). 

Symptoms. — In the majority of cases, acute articular rheuma- 
tism begins with a sudden attack at night. In some cases the 
pyrexia precedes the local manifestations for a few hours to one 
or two days. Before the attack patients often complain of mus- 
cular soreness, of a good deal of pain, stiffness and soreness of 
certain joints, of loss of appetite, coated tongue and constipa- 
tion. The development of the disease is denoted by an affection 
of one or more of the larger joints. The local symptoms are 
pain, tenderness, increased heat, swelling, and redness of the 
skin. Pain is especially excited by movements of the affected 
joints, or by jarring the bed, or by joressure over the joints. 



RHEUMATISM. 479 

Swellvng is most apparent in the knee, wrist, elbow, ankle, and 
smaller joints of the hands and feet, and is due to an effusion 
into the synovial cavity and surrounding tissues. The redness is 
due to an erythema. In some cases several joints are affected. 
but in other cases a single joint. The most characteristic featwre 
of a cafe rheumatism is its tendency to migrate from one joint to 
another. Rheumatism illustrates the law of parallelism in that 
corresponding joints are often affected together. In an analysis 
of 21 cases. Flint found but a single violation of this law. This 
disease, therefore, is eminently one of the bilateral or symmetri- 
cal diseases. The joints most frequently affected are the ankle 
and knee: next the shoulder, elbow and wrist; then the hip and 
fingers, and finally the -pine, the toes and the lower jaw. Acute 
articular rheumatism is always accompanied by more or less 
pyrexia. The axillary temperature in different cases varies be- 
tween 102° and 110° F. The pulse rarely exceeds 100 per 
minute. Sweating is a symptom more or less prominent, occur- 
ring especially at night. The sweat emits a notably sour odor. 
In connection with profuse sweating, sudamina or miliary vesicles 
frequently appear on the neck and trunk. Urticaria, erythema 
and herpes labialis sometimes occur in the course of the disease. 
The appetite is lost, thirst is urgent, the tongue is coated, the 
saliva is acid, usually the bowels are constipated, and the urine 
is diminished. There is sleeplessness. Endocarditis occurs in 
some cases of rheumatism. The inflammation, as a rule, affects 
the membrane situated upon the mitral valve. Pericarditis occurs 
less frequently. It is convenient to speak of these affections as 
complications, but, properly speaking, they are to be reckoned 
among the local manifestations of the disease. They rarely occur 
in patients beyond forty. Other rare complications are purulent 
meningitis, cerebral embolism, uraemia, insanity, bronchitis, 
pneumonia, peritonitis, nephritis, myocarditis, phlebitis, suppur- 
ative arthritis, erysipelas and pyaemia. In a small number of 
cases of acute rheumatism, important symptoms develop which 
are described under the names of cert hral rheumatism and rheu- 
matic hyperpyrexia. In these cases, there are very high fever, 
delirium, muscular twitchings, stupor, face cyanosed, etc. T: 
symptoms seem to be referable to some profound infection or in- 



480 A COMPENDIUM OF PRACTICAL MEDICINE. 

toxication which acts upon the thermic and other nervous cen- 
tres. The disease ends by self -limitation. The duration of acute 
articular rheumatism is three weeks to thirty days (Bartholow, 
Flint and Loomis). 

Differential Diagnosis. — Acute rheumatism may be mistaken 
for gout, pyaemia, synovitis, or simple acute arthritis, urethral 
rheumatism, and hysterical joint. Gout attacks the small and 
rheumatism the large joints. In gout the fever is lower, and the 
duration of the attack shorter than in rheumatism. Sweats and 
cardiac mischief distinguish rheumatism from gout. In gout the 
attack comes on at night in the great toe joint; there is a history 
of high living, and an excess of uric acid in the blood; not so in 
rheumatism. Gout is rare before thirty- five, while acute rheu- 
matism is a disease of early adult life. Tophi never form, in 
rheumatism, but are always present late in gout. In pyaemia 
there are recurring chills, sickly, sweet breath, slow development, 
jaundice, multiple abscesses, etc. Synovitis or acute arthritis is 
distinguished by its persistence in one joint, by the absence of 
sweats, of constitutional disturbance and of cardiac lesions, and 
by the graver local symptoms. Urethral or gonorrhoea!, rheuma- 
tism attacks one joint, usually the ankle or wrist, does not mi- 
grate, is slower to recover, is unaccompanied by fever, and is 
coincident with a urethral discharge. Hysterical joint is without 
swelling or change of temperature, and is only sensitive when the 
patient's attention is fixed on it (Bartholow, Flint and Loomis). 

Prognosis. — This disease is rarely fatal. The rule is that no 
crippling of the joints follows the acute attack. The worst 
legacy acute rheumatism leaves is a crippled valvular apparatus 
in the heart. Some authorities say that seventy-five per cent, of 
all cases of rheumatic fever are accompanied by cardiac inflam- 
mations, others say ^ve per cent. The complications — pericar- 
ditis, endocarditis and embolism make the disease serious. Ul- 
cerative endocarditis is a grave sequel of the disease, giving rise 
to fatal pyaemia. A strange sequel of rheumatic fever is chorea 
(Flint and Loomis). 

Treatment. — Rheumatic patients should have good hygienic 
surroundings. The temperature of the apartment should range 
from 68° to 70° F.; all draughts should be avoided, and the 



RHEUMATISM. 481 

patient should be clothed in flannel and covered with flannel 
sheets. The diet should be milk and seltzer-water, beef-tea and 
broths. Animal food and alcoholic stimulants should not be 
given during the active period of the disease. 

External Applications. — Cold, by means of ice-bags to the 
joints, has been strongly recommended. Friction with chloro- 
form and the tincture of aconite is a favorite plan with some. 
u Hot-packs" by means of flannel, or bathing the joints in warm 
laudanum and then covering them with oiled silk, is always 
grateful to the patient. Ethyl chloride or ether may be rubbed 
over the affected joints. Loomis is of the opinion that the blis- 
ter-treatment is no better than simply surrounding the joints with 
cotton-batting and oiled silk. But Dr. Greenhow finds that the 
blister-treatment is quite as successful as the treatment by sali- 
cylates, and open to less objection. The blistering- plaster should 
be applied about the inflamed joint, but not on it. Blisters re- 
lieve the pain remarkably, change the reaction of the urine from 
acid to neutral or alkaline, and prevent complications. Blisters 
may be utilized in all forms of the disease and combined with 
other plans of treatment. 

Internal Medication. — Rheumatism is the most unmanageable 
of all diseases so far as remedies are concerned. Grarrod thinks 
colored water is about as potent as anything. He claims that 
rheumatic fever is a self-limited disease. The alkaline treatment 
is the treatment in which alkalies play an important part. Two 
drachms of the bicarbonate of either potassium or sodium may 
be given in a state of effervescence by means of an ounce of 
lemon juice, or a half drachm of citric acid in four ounces of 
water every three or four hours. If the urine is alkaline at the 
end of twenty- four hours the quantity of alkali is diminished 
one -half. If the urine continues alkaline at the end of forty - 
eight hours, three drachms of alkali only are given on the third 
day. If the alkalinity of the urine persists, on the fourth day 
three grains of quinine with a half drachm of potassium bi- 
carbonate may be given three times daily. Cathartics may be 
given as required. The alkaline treatment relieves the pain, seems 
to shorten the duration, lessens the violence of the disease and 
prevents heart complications. The average duration of the cases 



482 A COMPENDIUM OF PRACTICAL MEDICINE. 

thus treated is put by Dr. Fuller at eleven days. Of 439 cases 
subjected to this plan there was not a fatal case, and only about 
two per cent, of cardiac complications. Loomis thinks that if 
long continued the alkalies do positive harm. The alkaline treat- 
ment is particularly applicable to the obese, florid, but flabby 
drinkers of malt liquors. The iron treatment is applicable to the 
pale, delicate anaemic young subject attacked with acute rheu- 
matism, in whom the alkalies are too depressing. A half drachm 
of the tincture of the chloride of iron to six ounces of water, may 
be taken through a glass tube every four hours. 

The salicylic or salicylate treatment is most applicable to the 
vigorous, able-bodied subjects of the rheumatic diathesis. Sali- 
cin, salicylate of soda and salicylic acid, to be effective, must be 
given in sufficient quantity to lower the temperature — a half- 
drachm of salicylate of sodium every four hours, until the pulse 
and temperature decline, may be taken as the standard. Al- 
though relief follows the administration of these remedies in 
two or three days, yet the tendency to relapses, heart depression 
and irritability of the stomach is very great. The salicylate 
treatment does not prevent the heart complications. The best 
results are obtained by the combination of the salicylate and the 
alkaline treatment. Loomis prefers salol to salicylic acid. He 
seldom uses the alkaline, or salicylate treatment, but extols anti- 
pyrine as the most efficient drug. Flint gives antipyrine in 
fifteen grain doses hourly, but does not give more than two 
drachms in twenty -four hours. For the intense hyperpyrexia in 
some cases, large doses of quinine may be given and cold spong- 
ing practiced. Dr. Kinnicutt gives 10 to 15 minims of the oil of 
wintergreen every two hours until eight doses have been taken. 
DaCosta has reported 30 cases treated with the bromide of am- 
monium in doses of 15 to 20 grains every three hours (Bartho- 
low, Flint and Loomis). 

Subacute Articular Rheumatism. — Is usually a sequel of the 
acute; it is attended by slight if any fever; the pain in joints is 
not severe, except on motion; swelling and redness are slight 
and usually limited to one or two large joints. It may last six 
weeks or even four months. There is always anaemia. The 



RHEUMATISM. 483 

treatment is a niilk diet, iron and cod-liver oil, a warm climate, 
and heat to the affected joints (Loomis). 

CHRONIC ARTICULAR RHEUMATISM. 

Is an affection of the articulations characterized by pain and 
stiffness, with some swelling, occurring chiefly after middle life, 
and influenced by atmospheric changes (Bartholow). 

Causes. — The chronic may succeed to the acute, or the case 
may be chronic from the first. It is a disease of adult and ad- 
vanced life. Bad hygienic surroundings, exposure to wet and 
cold, sudden atmospherical changes, and a residence in dark and 
damp dwellings predispose to it. It is often hereditary (Bartho- 
low and Loomis). 

Symptoms. — The affection remains fixed in certain joints; 
that is, it does not shift from joint to joint, as in cases of acute 
rheumatism. There is aching and constant pain in one or more 
of the larger joints. The affected joints are tender, painful to 
the touch, sometimes swollen, and their movements restrained. 
There is no fever. The aching and deep-seated pains are often 
worse at night. When it is the result of exposure, heat will give 
a grateful sense of relief; when a rheumatic diathesis exists, dry 
cold is better. Old people with rheumatic joints are great 
" weather prophets" often being able to foretell the coming of a 
storm. In the morning, on rising, the joints are stiff, their 
movements slow, rigid and jerking, so that dressing is accomp- 
lished with difficulty; but use renders them limber and supple. 
Movements of the joints may cause more or less creaking like 
rusty machinery (Bartholow, Flint and Loomis). 

Differential Diagnosis. — Chronic rheumatism may be mistaken 
for rheumatoid arthritis, or arthritis deformans. In the latter 
occur anatomical changes, dislocations, and distortions which do 
not belong to the history of chronic rheumatism. Arthritis de- 
formans is a steadily progressive disease, one joint after another 
being involved and never recovered from. In chronic rheuma- 
tism the large joints are mainly involved; in arthritis the small 
joints are usually first involved, then the large (Loomis V 

Prognosis. — Chronic rheumatism never affects the duration 
of life. It may persist throughout life (Loomis). 



484 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — Chronic rheumatism is benefited most by local 
treatment, such as blisters, iodine, belladonna, aconite, opium 
and chloroform liniments. If there is but little pain in the 
joints, ammonia and turpentine liniments are of service. Thick 
flannels should always be worn about the joints. Sponging the 
joints with hot water will relieve the pain and stiffness in some 
cases. Warm baths, the Turkish or Russian baths, with local 
douches, are often highly useful. Many of the hot saline springs 
for bathing have acquired a great reputation in the treatment of 
this form of rheumatism, cures being effected in cases that had 
resisted all other methods of treatment. The best results are 
obtained from the baths of the Hot Springs of Arkansas, the 
warm and hot springs of Virginia, the sulphurous waters of 
Kentucky and Saratoga, the Michigan springs, and St. Cather- 
ine's of Canada. Mud-baths are also employed on a large scale, 
for the relief of rheumatism and affections of the skin, in certain 
parts of Germany. Frictions of the affected parts with cod-liver 
oil are efficacious. The method of friction and movements, 
known as massage, is probably the best of the local means of 
treatment. Galvanism has been found serviceable. The posi- 
tive pole should be placed over the principal nerve-bundles 
.above, and the negative pole brushed over the joint-region. The 
electrical treatment must be kept up for a long time. 

Internal Medication. — Tonics such as iron, quinine, and 
strychnine should be employed. Cod-liver oil, according to 
Loomis, is the most useful of all internal remedies, and should 
be given for many months. Cod-liver oil should be given with 
a little ether to assist its digestion. A course of iodide of potas- 
sium often renders important service, if given many months. 
Muriate of ammonia may absorb deposits about the joints but it 
must be given for a long time. Bartholow has had excellent re- 
sults from the bromide of lithium. Colchicum, arsenic, bichlor- 
ide of mercury, guaiacum, oils of turpentine and cajeput, com- 
bined with sulphur have been recommended. The diet must be 
highly nutritious and absolutely non- stimulating. The patient 
should reside in a dry, warm climate (Bartholow, Flint and 
Loomis). 



EHEUMATOID ARTHRITIS. 485 

RHEUMATOID ARTHRITIS, 

Called also arthritis deformans, rheumatic gout, rheumatic 
arthritis, nodosity of the joints, dry arthritis, etc., is a chronic 
inflammation of the joints, without fever and without suppura- 
tion, progressive, and causing enlargement and deformity of 
various articulations (Bartholow). 

Causes. — It may occur at any age, but in the majority of 
cases patients are in middle life. Women are more liable to it 
than men. The smaller joints are most often involved in women; 
the larger in men. Damp dwellings, poor food, and mental de- 
pression are powerful predisposing causes. It is not an inherited 
disease. It occurs in the poorer classes of society, as a rule, and 
among those who suffer from hardships, exposure, and depriva- 
tions. Garrod holds that it may have its origin in the tubercular 
diathesis. A state of the nerve-centres is invoked to account for 
this disease (Bartholow, Flint and Loomis). 

Symptoms. — The disease is usually from the first and during 
its course, sub- acute. A feature of the disease is its progressive 
character. There is usually no constitutional disturbance. The 
affected joints are painful, especially on motion. A characteris- 
tic deformity of the fingers is a lateral deflection in the uluar 
direction. In the progress of the disease the anatomical changes 
lead to permanent extension or flexion of parts, subluxations, 
dislocations, nodulations and notable distortions. The soft parts 
about the joints usually atrophy. Early in the disease a friction 
crepitus is heard as the articular surfaces are rubbed upon each 
other. The skin is dry and harsh, and there is a great acidity of 
the stomach. In the worst cases all the joints are fixed in bony 
ankylosis (Bartholow, Flint and Loomis). 

Differential Diagnosis. — Arthritis deformans may be confound- 
ed with chronic rheumatism and chronic gout. Gout is hered- 
itary and occurs more in males. Arthritis deformans is rarely 
hereditary and occurs oftenest in females. Attacks of gout are 
periodic. Arthritis is progressive. Chalk-stones develop in the 
joints in gout and are never present in arthritis. Trie arid is al- 
ways in excess in gout, and never in arthritis (Loomis). 

Prognosis.— It is one of the most chronic of diseases. It may 
continue for ten, twenty or thirty years or longer. It never de- 



486 A COMPENDIUM OF PRACTICAL MEDICINE. 

stroys life, and is never recovered from. Patients with this dis- 
ease may attain very old age (Bartholow and Loomis). 

Treatment. — Qninine, iron, cod- liver oil, arsenic and strych- 
nine are indicated. Flannels should always be worn next the 
skin. Mineral waters and warm saline baths often do good. 
Bartholow recommends iodine and galvanism. He gives five 
minims of the compound solution three times daily. Iodine oint- 
ment may be rubbed into the affected joints. The galvanic cur- 
rent is often of great benefit (Bartholow and Loomis). 

RANULA. 

Is a sublingual cyst. 

Cause. — Banula is caused by an obstruction of one of the 
mucous glands situated beneath the tongue. They were once 
thought to be due to an obstruction of the salivary ducts. They 
are analogous to the mucous cysts of the lip. They contain a 
clear, glairy, mucoid fluid. They may be congenital. They 
may form a large swelling beneath the jaw. When large they 
press the tongue upward. They are, as a rule, painless, and 
merely give trouble by pressure (Bryant). 

Treatment. — The best treatment is to raise the upper wall 
of the cyst by means of a pair of pointed forceps, or a tenaculum, 
and with scissors to cut it off. Panas, of Paris, has lately in- 
jected these cysts with three to ten drops of a solution of chlo- 
ride of zinc (forty- five grains to the ounce) with success. In 
large tumors the cavity may be plugged with lint soaked in 
iodine, or with iodoform gauze, after it has been freely incised. 

Encysted tumors are also met with beneath the tongue, and 
may be mistaken for ranula; but these tumors have a distinct 
capsule and contain a cheesy, sebaceous secretion. They are 
probably congenital (Bryant). 

RETENTION OF URINE. 

When a patient is unable to pass his urine, he is said to have 
retention. When no urine comes clown from the kidneys, he is 
said to have suppression (Keyes). 

Causes. — Stricture (organic or spasmodic), enlarged pros- 
tate, inflammation or acute congestion of the prostate, spasm of 



KANULA KETENTION OF URINE. 487 

the cut-off muscles, true vesical paralysis, urethral calculus and 
inflammation of the urethra are capable of producing retention. 
Voluntary retention, often repeated and long kept up, may 
result in retention. Blunted sensibility of the bladder in typhus, 
small -pox, coma, in some syphilitic and inflammatory brain 
diseases, in shock from injuries, and in all conditions of spasm of 
the deep urethral muscles, are causes. Excess of drinking, with 
or without exposure to wet and cold, is an exciting cause. Re- 
tention in a child is generally from stone impacted in the 
urethra; in an adult from stricture; and in an old man from 
prostatic disease (Keyes). 

Symptoms. — The bladder may be often seen and felt, filling 
up the hypogastrium, perhaps reaching the navel. Pressure 
upon it usually causes a desire to urinate. Fluctuation may be 
made out between a finger in the rectum and the hand upon the 
hypogastric tumor. In retention there is always flatness over the 
pubes (Keyes). 

Treatment. — In retention from atony, paralysis, fever, etc., 
a soft catheter of medium size should be passed as often as re- 
quired and the bladder should be washed out on each occasion 
with a hot solution of borax in water. A piece of ice about the 
size of a chestnut introduced into the rectum may relieve reten- 
tion. In retention from spasmodic stricture caused by exposure 
to wet or cold and excess of drinking, the simple passage of a 
large metallic catheter well warmed and oiled is indicated. If 
the instrument will not pass no force should be employed, but an 
anaesthetic should be given and then it may pass. The old rem- 
edy of a hot bath cannot be too highly extolled in retention. A 
full opiate is also an invaluable remedy relieving the involuntary 
contraction of the bladder and the pain. In retention from in- 
flammatory stricture caused by gonorrhoea, the passage of a small 
catheter, or a hot bath and a full opiate are the best remedies. 
In retention from a blow in the perinamm, the simple passage of 
a catheter will usually suffice. In retention from presswre of an 
abscess in the perinceum, the treatment is to open the abscess 
(Keyes and Bryant). 



488 A COMPENDIUM OF PRACTICAL MEDICINE. 

ROSEOLA. 

Is a self-limited eruptive disease pursuing a course similar 
to measles. It is also called rose-rash, false measles, German 
measles, rotheln, etc Modern German authors call this disease 
rubeola (Bartholow). 

Causes. — Roseola is contagious and is essentially a disease of 
childhood. The causes are in a measure obscure. The delicacy 
of the skin in infancy and the active cutaneous circulation no 
doubt predispose to roseola and erythema. Summer weather 
with the derangements of the system which it produces is the 
most frequent cause of idiopathic roseola in young children 
Loomis and Smith). 

Symptoms. — Roseola is one of the mildest of the eruptive 
fevers. The eruption consists of rose -colored spots, varying in 
size from a pin's head to a large pea, slightly elevated, so that 
when the hand passes over the surface of the skin it feels some- 
what rough. Sometimes these spots occasion intense itching, 
are quite distinctly separated by healthy skin, and disappear 
under pressure. The eruption is frequently the first symptom 
of the disease. There may be slight soreness of the throat and 
mild catarrh of the air -passages. The eruption usually com- 
mences upon or about the neck and face. It bears considerable 
resemblance to that of measles. There is no fever in a majority 
of the cases. The whole duration of the eruption is from two to 
four days. There is a symptomatic roseola which appears in the 
course of various acute febrile diseases with the exception of 
syphilis (Bartholow, Loomis and J. L. Smith). 

Prognosis.— Is favorable. 

Treatment. — Regulate the diet and keep the patient in- doors. 

RELAXED UVULA AND PALATE. 

Treatment. — Tannic acid is much employed in relaxed con- 
dition of the mouth and throat. Elongated and relaxed uvula, 
relaxed palate, and follicular pharyngitis are effectively treated 
by insufflation of tannin. In chronic affections of the larynx 
mucous membrane, and of the vocal cords, no inhalation is more 



RASHES RESTLESSNESS. 489 

frequently serviceable than a solution of tannin (grs. x.-xx. to Si v.) 
applied by means of the handball atomizer. In chronic inflam- 
mation of the throat when the mucous membrane is relaxed, 
swollen, granular-looking, and covered with mucous or jms, a 
few applications of glycerine of tannin brace up the tissues and 
lessen or remove the hoarseness (Bartholow and Ringer). 

RASHES. (Medicinal). 



The administration of certain drugs has a tendency to bring 
out eruptions which are likely to be mistaken for diseases of the skin. 
Some persons are peculiarly prone to them and we know not 
why. Arsenic produces an erythema or an urticaria in some 
persons, when given in large doses. Belladonna or atrqpia may 
produce a scarlet rash. Bromides produce a rash similar to acne 
when given for some time in full doses. Quinine may give rise 
to an erythematous eruption. In some persons quinine jDroduces 
large patches of erythema, and always excites a violent urticaria. 
Chloral hydrate occasionally gives rise to a rash not unlike that 
of scarlet fever. Copaiba and cubebs produce a rash in some per- 
sons. Iodine and the iodides given for some time will produce a 
rash. Opium and morphia may produce an erythematous or 
urticarial rash which is very itchy. Tar, creosote, carbolic, 
digitalis, stramonium, strychnia, or salicylic acid occasionally 
produce an eruption in those who are taking them (Anderson). 

RESTLESSNESS. 

Einger says, that in several cases, he has seen aconite quiet 
the distressing restlessness of "fidgets," which affects men as well 
as women, and has known a few drops at bed -time calm the 
patient and give sound, refreshing sleep; if one drop is insufficient, 
it may be repeated hourly for three or four hours. Sponging 
with hot water will often induce perspiration, soothe the restless- 
ness of convalescence, and induce sleep (Ringer). 



490 A COMPENDIUM OF PRACTICAL MEDICINE. 

RELAPSING FEVER. 

Called also febris recurrens, typhus recurrens, spirillum 
fever, five- clay fever, seven- day fever, short fever, mild yellow 
fever, famine fever, hunger -pest, and dynamic fever, is an acute, 
infections, febrile disease, self -limited, and characterized by the 
occurrence of a febrile paroxysm, lasting about one week, suc- 
ceeded by an entire intermission of four or five days' duration, 
which is in turn followed by a relapse like the first seizure, 
although shorter. It has never been indigenous in this country. 
It is by no means a new form of disease. Accounts in the writ- 
ings of Hippocrates leave no doubt but it prevailed 2,000 years 
ago in the islands off Thrace. It has prevailed as an epidemic 
disease in most of the countries of Northern Europe. In 1844 
there were fifteen cases of relapsing fever in Philadelphia. The 
patients were Irish immigrants, all coming over in the same 
vessel. Dr. Dubois reported a few cases in 1848, and Dr. Flint 
fifteen cases in 1850-51. All these were among recent Irish im- 
migrants. It prevailed as an epidemic in New York City in 
1872-3, the disease having been imported by foreign immigrants. 
In 1865 there was a great epidemic in St. Petersburg. The name 
relapsing fever is to be preferred to any of the other appella- 
tions, as it is based on one of the most striking of the peculiari- 
ties of the disease (Bartholow, Flint and Loomis). 

Morbid Anatomy.— The lesions are those of an acute infecti- 
ous disease. The spleen is enlarged, due to congestion and 
hyperplasia of its lymphoid elements. The liver is also enlarged 
and is the seat of parenchymatous degeneration. The kidneys 
are swollen. The mucous membrane of the intestine is inflamed. 
Petechige of the skin are present in about 10 per cent, of the 
cases. The myocardium may be affected with a fatty degenera- 
tion almost as intense as that in phosphorus- poisoning. The 
blood is dark and coagulates imperfectly. In 1873 Obermeier 
discovered a spiral -shaped bacterium in the blood of relapsing 
fever patients. This parasite has been found in the blood in no 
other disease (Flint). 

Causes. — Pelajjsing fever is a distinctly contagious affection. 
The poison acquires the greater activity the more filthy, crowded 



RELAPSING FEVER. 491 

and unhealthy the population amid which it prevails. Articles 
of clothing will retain the contagious principle for a long time, 
and those who have been in the presence of the sick can convey 
the poison to the healthy at a distance. Drinking water may be 
contaminated and spread the poison. The disease attacks by 
preference the young, the liability lessening after thirty and ap- 
parently ceasing after fifty. One attack does not afford immun- 
ity against subsequent attacks. The natural home of relapsing 
fever is Ireland. The period of incubation ranges between five 
and seven days, rarely nine. Facts go to show that it is not a 
highly contagious disease. Considerable exposure is generally 
necessary. The disease is not likely to be contracted from single 
23atients in well ventilated rooms. Destitution and deficient 
alimentation are auxiliary causes. That the contagium is con- 
tained in the blood does not admit of doubt. In accordance with 
the germ theory, the first paroxysm of relapsing fever is due to 
a brood of spirochoetce. Their existence terminates in about a 
week, as a rule, and the first febrile paroxysm then ends. The 
germs remaining in the body give rise to a second brood and 
there is the relapse of the fever. In rare instances a third and a 
fourth brood are produced. The contagium is probably contained 
in the breath and the cutaneous exhalations (Bartholow, Flint 
and Loomis). 

Symptoms. — The recurrence of the paroxysm of fever, or the 
relapse, is the distinctive feature of this disease. The attack is 
sudden. It is marked by a distiuct chill with fever, frontal head- 
ache, vertigo, pain in the limbs, joints and back and usually 
nausea and vomiting. Sweats may, at first, follow the chills. 
The vomit consists first of the contents of the stomach, then of a 
yellowish material and this may be followed by black vomit 
similar to that of yellow fever. The temperature usually attains 
its highest point within the first twenty-four hours — 104° F. to 
even 109° F.; and the pulse reaches 140, 150, or even 160 beats 
j3er minute. The cessation of the fever is as abrupt as its invas- 
ion. The duration of the primary paroxysm in the majority of 
cases is between five and seven days. It maybe two or fourteen 
days. The average duration of the apyrexial period or inter- 
mission is about seven days. The relapse, like the primary attack, 



492 A COMPENDIUM OF PRACTICAL MEDICINE. 

is sudden, with chilly sensations, fever, etc. The relapse also 
ends suddenly with profuse sweat. The duration of the relapse 
varies between three and five days. It may he one or ten days. 
The relapse does not always occur. But two, three, four, and 
even fine relapses have been observed. The duration of the 
second intermission is eight or nine days, and that of the third 
paroxysm about three days. The duration of the disease aver- 
ages about twenty-five days. The tongue is coated and soon 
becomes very dry and sore. Herpes labialis may occur. Epistaxis 
is frequent. There may be diarrhoea or constipation. Meteorism 
is common. Tenderness in the epigastric and iliac regions on 
pressure is common. Jaundice is developed in some cases. A 
dirty, yellowish color of the skin is present in most cases. 

During the first paroxysm, pains in the loins, the calves of 
the legs, and the muscles in other situations are generally much 
complained of. They are never wanting. The muscular pains 
do not cease with the ending of the paroxysm, but continue dur- 
ing the intermission. They are more or less prominent during 
the relapse. The pains are sometimes referred to the bones. The 
mind is clear. The perceptions are not blunted in this disease as 
they are in typhus and typhoid fever. There is no coma- vigil, no 
subsultus and no carphologia. There is no characteristic erup- 
tion. Sudamina or miliary vesicles, sometimes are observed 
when profuse perspiration occurs. The face is more or less 
flushed but there is not that degree of capillary congestion, 
marked especially on the cheeks which exists in typhoid fever 
or the dingy complexion which characterizes typhus. Eelapsing 
fever, when it attacks pregnant women, always leads to miscar- 
riage or abortion. The patient goes on from day to day gradually 
getting worse; the fever becomes more and more intense; loss of 
strength and emaciation are progressive and the muscular pains 
are more severe; when on the seventh day of the fever a remis- 
sion suddenly occurs. CEdema of the feet due to general anaemia 
is often quite marked during convalescence. Recovery is tedious 
( Bartholow, Flint and Loomis). 

Differential Diagnosis. — Relapsing fever may be confounded 
with typhus, typhoid, yellow fever, small -pox and measles. In 
typhus, the dusky face, contracted pupils, absence of all abdoin- 



RELAPSING FEVER SALIVATION. 493 

inal pain, peculiar smell, stupor, apathy of mind, and the path- 
ognomonic eruption on the fifth or seventh day will be sufficient 
to distinguish it from relapsing. In typhoid the slow invasion, 
the "step-ladder" rise in temperature, the eruption and the 
characteristic diarrhoea will distinguish it from relapsing. In 
yellow fever the pulse is rarely over 110, the spleen is normal 
and only a remission occurs. In small-pox^ the eruption appears 
on the third day. In measles the eruption follows a common 
cold in the head. Of course the prevalence of relapsing fever 
will assist the diagnosis (Loomis). 

Prognosis. — Is always good. About three per cent, of the 
cases die. Sudden syncope is the greatest danger (Loomis). 

Treatment. — Dr. Rutty stated more than a century ago that 
all those cases of relapsing fever which were abandoned to whey 
and the good providence of God recovered. Loomis would give 
very little medicine in this disease. If there is any evidence of 
heart- failure, he would give digitalis and stimulants, with milk 
diet and free ventilation. For the pains, Bartholow advises 
morphine hypodermically; and for the nausea, half a grain of 
carbolic acid in cherry-laurel water. Tonic remedies are 
indicated. 

SALIVATION. 

Is harmful and should not be aimed at. The greatest effect 
that it is allowable to produce by mercury is to "touch the 
gums. 11 When the gums are touched there will be an increased 
flow of saliva, a faint coppery taste in the mouth, and some ten- 
derness of the gums, tongue and mouth (Keyes). 

Causes. — The cause of salivation is special idiosyncrasy with 
a small dose of mercury, or no idiosyncrasy with large doses. A 
mouth kept dirty or containing bad teeth is more apt to suffer. 
The influence of cold and wet during a mercurial course may 
produce it (Keyes). 

Symptoms. — In salivation, the salivary fluids flow freely, 
sometimes to an enormous extent; the breath is fetid, the metal- 
lic taste is very marked; the gums are sore; the teetli fee] too 
long for the patient to shut his mouth; the tongue swells, show- 
ing marks of the teeth, and the lips and cheeks may also become 



494 A COMPENDIUM OF PRACTICAL MEDICINE. 

tumefied. Often there is fever. The teeth may fall out, or 
portions of the soft or bony parts necrose. The articulation is 
indistinct and painful and deglutition almost impossible (Keyes). 
Treatment. — During salivation, or any sore mouth from 
mercury, ten to twelve grains of chlorate of potash to the ounce 
of water, or any bland fluid, may be used as a mouth wash and 
gargle. At least one drachm of chlorate of potash should be 
taken by the stomach daily. A mild solution of carbolic acid, 
or of permanganate of potash, should be occasionally used as a 
gargle where there is great fetor of the breath. The free use of 
the hot bath is of advantage, and a mild diuretic may be given. 
A little tincture of belladonna may be given to restrain the sali- 
vary flow. Astringent gargles, Labarraque's solution, tincture 
of myrrh, hot milk, cold tea may be used as mouth washes 
(Keyes). Alcohol diluted with water may be used as an astrin- 
gent gargle in salivation. Bromide of potassium checks the 
salivation sometimes occurring in pregnancy. A gargle of two 
drachms of tincture of iodine to eight ounces of water has been 
recommended to allay mercurial salivation (Ringer). 

SATYRIASIS. 

Is constant desire with erection; erotic delirium. It is also 
a brain disease. Acton mentions the case of an old man who 
was eminently satyiiasic, so much so that he would masturbate 
in the presence of ladies. Dying, a tumor of the size of a split 
pea was found in the pons Varolii (Keyes). 

SCABIES. 

Called also "the itch" is a highly contagious disease, especi- 
ally in persons who are inattentive to cleanliness. It is com- 
municated by sleeping with, or on the beds of those who are 
affected, or by coming much in contact with them in any way. 
It may also be transmitted from the domestic animals, such as 
the cat. It is oftener met with in winter than in summer 
(Anderson). 

Causes. — The cause of u the itch 11 is an animal parasite, 
called adarus scabiei. This burrows into the skin particularly 



SCABIES SCAELET FEVER. 495 

between the fingers and toes, about the wrists, on the buttocks r 
abdomen, and the upper part of the penis (DaCosta). 

Symptoms. — The disease is attended with excessive itching T 
which is increased at night, and with an eruption usually due to 
the irritation of scratching. At the close of our civil war we had 
a form of itch very prevalent in this country, the so-called army 
itch, which was a very chronic affection and no age or social 
state was exempt from it. The itching was intense (DaCosta). 

Treatment. — Scabies can be easily cured. The treatment 
should be exclusively local. The indications are: 1. To destroy 
the acari and their eggs. 2. To do so without irritating the 
shin. 3. To remove the eruptions called forth by the scratch- 
ing. At the Glasgow Hospital for skin diseases, each patient 
affected with scabies, is told to scrub the lohole of his body (ex- 
cept the head) as firmly as possible with black soap and water, 
and to sit in a hot bath for twenty minutes; also to rub some of 
the ointment given him firmly into the skin of the whole body 
(except the head) for twenty minutes. Let the ointment remain 
on the body all night. Repeat these processes every night for 
three nights, but no oftener. Besides the above, he is ordered to 
put all his washing clothes into boiling water, and to iron all 
others with a hot iron. The best parasiticide in this disease is 
sulphur / but it is apt to irritate and inflame the skin. Anderson 
prefers an ointment of storax, for it not only kills the acari, but 
also has a pleasant aroma, and rather soothes than irritates the 
skin. Burchard strongly recommends the use of balsam of Peru. 
One thorough application to the dry skin is sufficient, or the bal- 
sam may be diluted with two parts of lard and applied oftener. 
Lard may alone effect a cure if applied for two weeks. 

SCARLET FEVER. 

Called also scarlatina, is an acute infectious and contagious 
disease, self-limited, characterized by a peculiar exanthem, an 
affection of the throat and albuminuria, and terminating in des- 
quamation of the epidermis. This name has been given on 
account of the bright red appearance of its eruption. It is a 
disease of childhood, but may occur at any age (Bartholow and 
Loomis). 



496 A COMPENDIUM OF PRACTICAL MEDICINE. 

Causes. — The cause of scarlet fever is a contagion, a micro- 
organism, which is transferable from the sick to the healthy. 
No specific microbe of the disease has as yet been discovered. It 
occurs both in the sporadic and epidemic form, but never arises 
spontaneously. It may be conveyed by contact, through the 
atmosphere, by animals, and by clothing; it is therefore a porta- 
ble disease. An epidemic of scarlet fever has been traced to the 
milk supply. Quain says : "Milk is a great medium for carry- 
ing scarlet fever, and cream even more than milk often carries it 
from the sick to the well." The susceptibility to scarlatina is 
not universal. Some seem to have a certain idiosyncrasy which 
prevents them from contracting the disease. Scarlet fever can 
be communicated from one individual to another by inoculation 
with the serum from a minute vesicle on the skin of a scarlet 
fever patient. But those who have been inoculated for scarlet 
fever have suffered more severely than those who con- 
tracted the disease in the ordinary way. The scarlet fever 
poison can be conveyed by clothing, but when a physician 
makes a visit of ordinary length, he is not likely to so 
convey the disease. Nurses who have been with a scarlet fever 
patient for a number of days and whose clothing has become 
filled with the poison, may carry the disease. The poison is 
probably contained in the skin and its excretions and epithelium 
and also in the breath and exhalations from the throat. The 
period at which the disease is most infectious is probably the 
highest point of the disease; but it is present at any period from 
the beginning to the end. The disease but rarely occurs twice 
in the same individual; although it may recur from one to three 
weeks after the close of the first attack and is then de- 
scribed as a relapse. The period of incubation varies from one to 
fourteen days, the average duration being from three to seven 
days. The shortest period is that of a patient mentioned by 
Trousseau, in whom the disease appeared in a day after expos- 
ure. Within the first six months of infant life there is little lia- 
bility to the disease; but the greatest susceptibility to the influ- 
ence of the poison exists between the second and seventh years, 
and declines slowly to the tenth, and after this more rapidly; 
but it does occur in old age. Those who have just undergone 



SCARLET FEVER. 497 

surgical operations seem to be especially prone to contract the 
disease. Women during convalescence after child-birth are very 
liable to contract scarlet fever. 

Contagiousness. — The area of the contagiousness of scarlet 
fever is small; it apparently embraces only a few feet. It is not 
so contagious as pertussis, variola, varicella, or measles. 

Variations in Type. — The type of scarlet fever varies 
greatly in different epidemics. One child may have it so mildly 
that little treatment is required; while another has the malignant 
form, and soon succumbs (Bartholow, Flint, Loomis and J. L. 
Smith). 

Morbid Anatomy. — It has no characteristic anatomical lesions 
except those which occur in the skin and mucous membranes. 
The eruption is due to an intense hyperemia, which is limited to 
the area of the spots, but which is general when the spots 
coalesce (Bartholow and Loomis). 

Symptoms. — There are three stages of scarlet fever: First, 
the stage of invasion. Second, the stage of eruption. Third, 
the stage of desquamation. The period of invasion is sudden 
and violent. A strong chill is the initial symptom in adults; in 
children there is a violent convulsion, or a severe attack of vom- 
iting, with prostration. Headache of a very intense character, 
general muscular pains and high fever succeed to the chill. In 
a short time the temperature rises to 104°, 105°, or higher; the 
skin is hot; the throat burns and is red and swollen; the tongue 
is coated. The affection of the throat is due to the efflorescence 
which appears in this situation before its appearance on the skin. 
Epistaxis is common. The average duration of this stage is 
about twenty -four hours, and the eruption usually appears on 
the second day. It may appear earlier or later. 

Stage of Eruption. — This stage in children is sometimes 
ushered in by a transient convulsion. The eruption appears on 
the neck and upper part of the chest first, and then on the cheeks 
and forehead. The first appearance is in the form of minute red 
dots or specks, and these may coalesce and form a solid redness. 
Exceptionally, the eruption remains punctiform, that is, in the 
form of distinct maculae or spots. The redness is vermilion or 
scarlet. It is not uniform like erysipelatous redness, but on close 



498 A COMPENDIUM OF PRACTICAL MEDICINE. 

inspection the patches are seen to be studded with points. The 
redness momentarily disappears on pressure, and white lines are 
produced by drawing a pointed hard substance over the reddened 
surface. In some cases the whole cutaneous surface is covered 
with the efflorescence presenting an appearance which has been 
compared to that of a boiled lobster. The integument is slightly 
swollen. This is evident of the face and is apparent to the pa- 
tient wmen the hands are closed. The feet are swollen. The 
eruption is sometimes accompanied by more or less burning and 
pruritus. The eruption attains its maximum of intensity and 
diffusion on the third day after its iirst appearance. In certain 
cases the eruption may be slight or wanting. 

The throat is more or less affected in the vast majority of 
cases. The tongue is coated early, and while the coating remains, 
frequently the papilla projecting through it have the appearance 
of a number of red points. In the progress of the disease, the 
coating exfoliates, leaving the surface of the tongue clean and 
reddened; and the papillae being enlarged, the appearance is 
strikingly like that of a ripe strawberry. The strawberry -like 
tongue is a pathognomonic symptom, and is peculiar to this dis- 
ease. The pyrexia is not diminished, but, as a rule, is increased 
after the appearance of the eruption. The pulse is frequent, 
from 100 to 140 or more, is quick and always compressible, and 
is never dicrotic. The skin usually is dry and the heat as felt by 
the hand is often pungent. The thermometer in the axilla shows 
an increase of temperature to 105° F. and in severe cases it may 
reach 112° F. The duration of the stage of eruption in the ma- 
jority of cases is between four and six days. 

Stage of Desquamation. — With the disappearance of the rash, 
desquamation commences. The period of desquamation lasts 
about two weeks, during which time there is the greatest danger 
of communicating the disease. At the end of this period, if no 
complications occur, the patient is well. Where the skin is thick, 
as on the palms and soles, the ejDidermis peels off in extensive 
patches. The entire period of scarlet fever when it runs its 
regular course is from two to three weeks. 

Scarlet fever is liable to irregularities. In a certain class 
of cases, complications arise from the overwhelming of the cere- 



SCAELET FEVEE. 499 

bro-sjnnal system with the scarlatina poison. In these cases 
there are delirium, stupor, restlessness, wandering, and picking 
at the bed-clothes. The most common sequel of scarlet fever is 
albuminuria with general dropsy. This follows the disease in a 
considerable proportion of cases. The time of its occurrence is 
between ten and twenty days after the date of desquamation. 
The symptoms are those of acute diffuse nephritis. CEdema of 
the face and lower extremities is first observed, and anasarca 
frequently follows. Effusion sometimes takes place into the 
serous cavities. The urine is scanty; sometimes it has a smoky 
appearance, and it may be distinctly bloody. It is usually loaded 
with albumin. Ursemic coma and convulsions, pulmonary 
oedema, and oedema of the glottis are grave accidents incident to 
the renal affection. Acute nephritis after scarlet fever rarely 
ends in chronic renal disease. Pleuritis, pericarditis, and acute 
articular rheumatism are occasional sequels as well as concomi- 
tants of scarlet fever. Chorea, external otitis and otitis media 
are sequels in some cases. A purulent discharge takes place 
from the ears, and sometimes there is considerable deafness. A 
serious complication of scarlet fever is diphtheria (Bartholow, 
Flint, Loomis and J. L. Smith). 

Differential Diagnosis. — Scarlet fever may be mistaken for 
measles, small-pox, roseola and an erythema which sometimes ap- 
pears in surgical cases. In measles the appearance of the erup- 
tion is preceded by a cough and coryza, not so in scarlatina. Be- 
sides, the eruption of measles first appears on the face, whereas 
the eruption of scarlet fever first appears on the neck and chest. 
The incubation period is shorter and fever higher earlier in scarlet 
fever than in measles. In small-pox, the eruption, if confluent, 
may resemble that of scarlet fever for the first twenty -four hours 
yet the development of the first vesicle settles the question. In 
erythema the redness spreads in a very irregular manner, and the 
throat symptoms and strawberry-like tongue of scarlet fever are 
absent. In roseola the throat affection is much milder than in 
scarlet fever. In roseola the white line that the finger leaves 
disappears immediately, while in scarlatina it remains (Loomis 
and Flint). 



500 A COMPENDIUM OF PRACTICAL MEDICINE. 

Prognosis. — Is always uncertain in scarlet fever. The rate 
of mortality ranges from one death in five to one in twenty. The 
conditions of a favorable prognosis are early eruption, mild 
throat symptoms, a temperature not higher than 104° F., pulse 
not above 120 and mild cerebral symptoms. Autnmn is the most 
unfavorable season. Malignant cases of scarlet fever in which 
no eruption appears, prove rapidly fatal. The patient is over- 
whelmed by the scarlatina or active blood poison. The period 
of greatest mortality is from infancy to five years of age 
(Loomis). 

Treatment. — I. Prophylaxis or Prevention. — The prophy- 
laxis of scarlet fever is a system of the strictest quarantine. The 
sick must be removed from the healthy. Fresh air renders the 
contagion of scarlet fever less powerful; therefore, free ventila- 
tion is of the utmost importance. All the clothes and excretions 
of the patient, the nurse and everything contaminated by the 
contagion should be disinfected. The funeral of those dying of 
scarlet fever should not be public. The sick should not be 
.allowed to leave their apartment until desquamation is com- 
pleted. Belladonna has no power to prevent this disease, as was 
•once thought. 

II. Medicinal Treatment. — The medicinal treatment of 
scarlet fever is almost entirely expectant. It is a disease which 
cannot be aborted, but tends to recovery. The bed and body 
linen should be frequently changed. The patient should be 
bathed with warm water once or twice daily during the period 
of desquamation. The baths will relieve the kidneys by keeping 
the skin active. If the temperature of the patient rises above 
104° F., it should be reduced by some means. Loomis says, 
"Unless the temperature in a case of scarlet fever ranges above 
105° F., do not apply cold to the surface or give antipyretics. " 

In all cases the patient is to be sponged frequently with tepid 
water, and if there is intense burning of the surface, a saline is 
to be added to the water. Sponging in this manner will give the 
patient very great comfort. Of all the remedies which Loomis 
has employed for the throat complications, cold carbonic acid 
water or pieces of ice afford most marked relief. In the ad- 
vanced stages of the disease, hot applications may be used extern- 



SCLEROSIS OF THE BRAITsT. 501 

ally to the neck and warm water gargles and steam inhalations 
internally. For the ulcers sometimes seen in the throat of scarlet 
fever patients, a spray of carbolic acid, tincture of iron, chlorate 
of potash, or tannic acid may be used. Stimulants may be given 
early if there is much depression. Whenever kidney symptoms 
are developed, dry or wet cups should be applied over the region 
of the kidneys, upon either side of the spine. At the same time 
the temperature of the sick-room is to be raised to 73° or 74° F., 
the body of the patient covered with flannel, hot-air or warm- 
baths are to be given and also diuretics. Of the diuretics, digi- 
talis will act most favorably. Small doses of calomel may be 
combined with the digitalis and continued for two or three days. 
The patient may drink water freely. If convulsions occur, opium 
may be given (Loomis). 

SCLEROSIS OF THE BRAIN. 

By the term sclerosis is meant a disease characterized by the 
formation of isolated patches or nodules of sclerotic tissue (har- 
dened tissue). We have sclerosis of the liver, of the kidney, of 
the lung, of the brain and spinal cord, etc. 

Independent of cerebro- spinal sclerosis 1 this is a compara- 
tively rare condition. Cerebral sclerosis is a chronic interstitial 
inflammation, following hyperemia of the neuroglia. It may be 
diffused or multiple (Loomis). 

Morbid Anatomy, — On section, masses of gray, hard, well- 
defined, transparent sclerotic tissue are found, varying in size 
from one -fourth to one inch (Loomis). 

Causes. — Are obscure. It is intimately connected with 
changes in the vascular system. Sclerosis of the brain is often 
found in epileptics and in the insane (Loomis). 

Symptoms.— Are a gradual enfeeblement of the mental 
powers, especially memory, muscular tremors, headache, dizzi- 
ness and vertigo. One group of muscles after another becomes 
paralyzed. Melancholia, pains in the extremities, and a sense of 
formication are common. Patients may gain flesh with this 
disease. Strabismus may be present. . A peculiar symptom is 
festination — the patient bends forward and trots along like one 



502 A COMPENDIUM OF PRACTICAL MEDICINE. 

trying to run after he is tired out. In rare instances the first 
symptoms are convulsions of an epileptiform character, followed 
by hemiplegia (Loomis). 

Differential Diagnosis. — Sclerosis of the brain may be con- 
founded with cerehral softening, paralysis agitans or tumors. 
Softening occurs in old age ; sclerosis occurs from youth to 
middle age. The paralysis in softening is in one set or group of 
muscles, and if it extends, does so in an orderly manner. There 
is anaesthesia, and the symptoms develop more suddenly than in 
sclerosis. Paralysis agitans is marked by rhythmic tremor 
passing from one upper to the corresponding lower limb; there 
is a peculiar deformity of the fingers and toes; the facial muscles 
are not affected, and the patient inclines to the paralyzed side in 
walking. Paralysis agitans occurs only after the fortieth year, 
and is accompanied by no cerebral symptoms. Cerebral tumors 
are attended by headache, convulsions and signs of brain irrita- 
tion without loss of mental power (Loomis). 

Prognosis. — Sclerosis of the brain may continue from five to 
eight years, but it is progressive and always fatal (Loomis). 

Treatment. — Little can be done for this disease except to im- 
prove the general health. Vulpian recommends chloride of iron, 
Mitchell the bi- chloride of mercury, Hammond the chloride of 
barium and many the phosphate of zinc. Nitrate of silver and 
strychnia are said to relieve tremor (Loomis). 

CEREBRO=SPINAL SCLEROSIS. 

Is a disease characterized by the formation of isolated 
patches or nodules of sclerotic tissue (hardened tissue) in the 
brain, pons, medulla, cerebellum and spinal cord (Bartholow). 

Morbid Anatomy. — The disease in the brain and cord to the 
naked eye, appears as glistening nodules underneath the pia, 
varying in size from a minute object to that of a walnut (Bar- 
tholow). 

Causes. — The exciting causes are damp and cold, sudden 
chilling of the body, traumatism, severe, long- continued brain 
work or physical exercise, powerful and prolonged moral emo- 
tion, chagrin and anxiety. The most powerful predisposing 



CEREBRO SPINAL SCLEROSIS. 503 

cause is heredity. Continued jarring of the body is also thought 
to produce the disease. It occurs in nervous people with hys- 
teria and after acute febrile diseases. It is essentially a disease 
of early life, few cases occurring outside the limits of fifteen and 
thirty -five (Bartholow and Loornis). 

Symptoms. — It may be insidious or sudden in its develop- 
ment. If it come on insidiously, the patient complains vaguely 
of headache, vertigo, muscular weakness, mental disturbances, 
and queer feelings as formications, itchings, burnings, etc., in the 
limbs. There are nausea, vomiting, cardialgia, loss of co-ordin- 
ating power, and impairment of the special senses. There is 
more or less paresis in the extremities, and shaking tremor when 
an attempt is made at voluntary motions. In some cases the 
patient becomes childish or morose. During prolonged fits of 
yawning, sobbing, or laughing, the respirations become stridulous. 
The patient talks in a low monotone or whisper, dividing his 
words in syllables, and empasizing them as when scanning a line 
of poetry. A girdle pain is felt about the abdomen. Amblyo- 
pia, nystagmus, diplopia, and inequality of the pupils evidence 
invasion of the base of the brain and optic tracts. In the ad- 
vanced stage acute bed-sores, loss of sexual power and control of 
the sphincters become marked symptoms (Bartholow and 
Loomis). 

Differential Diagnosis. — Cerebro- spinal sclerosis may be mis- 
taken for paralysis agitans, locomotor ataxia, and cerebral hem- 
orrhage. In paralysis agitans the fine tremor exists when the 
patient is at rest, and is not accompanied by shaking of the 
head; while in sclerosis the head is always involved, the symp- 
tom ceasing as soon as the patient is at rest. Paralysis agitans 
is rare before forty; and multiple sclerosis is rare after thirty - 
Hve. Changes in the voice and speech and ocular symptoms are 
present in disseminated sclerosis and absent in paralysis. 

In locomotor ataxia, the peculiar tremor, impairment of voice 
and speech, and nystagmus that belong to disseminated sclerosis 
are absent. In the former disease we notice the peculiar iron- 
band sensation, vesical symptoms, the Meniere's vertigo, the very 
slow and late appearance of paretic symptoms, the lightning-like 
and agonizing neuralgic pains, and the peculiar double beat in 



504 A COMPENDIUM OF PRACTICAL MEDICINE. 

walking, the heel being put down first, all of which are in marked 
contrast to the symptoms of multiple cerebro- spinal sclerosis. 
When sclerosis is ushered in by loss of consciousness which 
rapidly deepens into coma, with marked hemiplegic symptoms, it 
may be mistaken for cerebral hemorrhage / but in sclerosis the 
temperature is very high during these peculiar attacks — 104° or 
105° F., — the hemiplegia passes off soon (Loomis). 

Prognosis. — The average duration of this disease is five to 
ten years. The termination by death is the only one known. 
After six or seven years emaciation sets in, a marasmus is devel- 
oped, and the patient is apt to die from intercurrent disease 
(Bartholow and Loomis). 

Treatment. — Improve the nutrition. Chloride of gold, phos- 
phate of zinc, nitrate of silver, chloride of barium, potassium, 
iodide and bromide, arsenic, belladonna, calabar bean, and ergot 
have all been used with some success. The galvanic current 
benefits in some cases. For the pain morphine should be given 
(Bartholow and Loomis). 

SCROFULA. 

Is a constitutional dyscrasia, hereditary or acquired, charac- 
terized by changes inflammatory and hyperplastic, occurring for 
the most part in the lymphatic system, the skin, mucous mem- 
branes, connective tissue, osseous structures and viscera. 
Scrofula is also known as struma, the strumous diathesis, tuber- 
culosis, the tuberculous diathesis. Scrofula is a disease chiefly of 
infancy and childhood, but early adult life is not entirely exempt. 
Scrofulous persons are liable to chronic inflammations of the 
lymphatic glands, especially those of the neck, which enlarge, 
often coalesce with each other, and undergo cheesy metamorpho- 
sis (Bartholow, Loomis and Smith). 

Morbid Anatomy. — The characteristic lesions of scrofula are 
to be found in the lymphatic glands, although the skin, mucous 
membranes, bones, joints, and organs of special sense may be in- 
volved. Anaemia necrosis or suppuration sometimes occurs in 
the glands. On the skin the lesions appear as eruptions. Im- 
petigo of the eyelashes and external otitis are common strumous 



SCROFULA. 505 

diseases. Scrofulous inflammation of mucous membranes is 
marked by a thick, sticky exudation with a tendency to form 
scabs. The bones most frequently involved are those of the 
ankle, lower part of the femur, and the vertebrae. The scrofulous 
development may assume the form of synovitis, osteitis, perios- 
teitis, or general arthritis. A pharyngitis often gives rise to 
hyperplasia of the tonsils (which are lymphatic glands) in scrof- 
ulous individuals (Loomis). 

Causes. — Scrofula is congenital or acquired. The children 
of intemperate, jDhthisical, syphilitic, cancerous and very old or 
very young parents, develop early all the characteristic features 
of the scrofulous diathesis. Children of consanguineous mar- 
riages are especially liable to scrofula, and to this has been attri- 
buted the scrofula of royal families. Healthy children may ac- 
qire scrofula through antihygienic surroundings, from improper 
food, overcrowding, lack of fresh air, exercise and sunlight. In 
the infant scrofula is sometimes produced by insufficiency or 
poor quality of the breast-milk, or too protracted nursing at the 
breast. Some think that scrofula is a local tuberculosis from 
the fact that scrofulous glands sometimes contain the tubercle 
bacillus. Birch -Hirchf eld found tubercles in nine out of ten 
lymphatic glands removed from the necks of scrofulous patients. 
Others think that the tubercle bacillus found in scrofulous 
glands is accidental. Rabl tabulates 1,000 cases of scrofula as 
regards the causation, as follows: 79 had scrofulous parents, 446 
had tuberculous parents, 356 lived in damp dwellings, 25 were 
subjected to other bad hygienic surroundings, 69 could be as- 
cribed to acute infectious diseases, such as small -pox, measles, 
scarlet fever, etc., 14 to vaccination, 7 to decrepitude and 4 to 
consanguinity of parents. Kabl also expresses the opinion that 
in certain cases scrofula results from syphilis in the parent or 
grand-parent. He believes that syphilis in the parent causes 
scrofula in the child by diminishing the power of resistance to 
the causes which produce the latter affection. He thinks that in 
this matter parental syphilis gives rise in some children to symp- 
toms identical with those of scrofula, while in other children it 
gives rise to syphilitic symptoms. Dr. J. L. Smith is of the same 
opinion (Bartholow, Loomis and J. L. Smith ). 



506 A COMPENDIUM OF PRACTICAL MEDICINE. 

Symptoms, — Some children with a scrofulous habit have a 
transparent, white skin, with delicate blue veins; large, lustrous 
eyes; bright red lips, etc. Others may have large heads with 
coarse features, a thick skin, which has a flabby, spongy feel, an 
enlarged abdomen, and cervical glands. Chronic inflammations 
of the skin about the face and scalp are frequent. Coryza, con- 
junctivitis, otorrhcea, laryngitis and bronchitis are persistent. 
Synovitis may appear. A slight injury may be the starting 
point of caries and necrosis. Glandular enlargements are the 
most common symptoms. This enlargement, which is non-inflam- 
matory and due to cellular hyperplasia, is very gradual, and 
forms a smooth, firm tumor. These glands may inflame and sup- 
purate. The disease progresses slowly, but toward puberty pul- 
monary disease is apt to be established (Loomis and Smith). 

Prognosis. — Is good when the patient is seen early. Scro- 
fulous children may die from tuberculous intestinal disease, 
acute hydrocephalus or croup. 

Treatment. — The diet should be nutritious and easily di- 
gested. Cod-liver oil should be given daily during the greater 
part of infantile and adult life. The syrup of the iodide of iron 
should be given in one to two -drop doses three times daily to a 
child of six months, and Ave drops to a child of four years. The 
following is a good formula: 

Jfc Olei morrhuse §iv. 

Syrupi calcis lactophosphatis 

Aquae calcis — aa §ij. — M. 

Sig. : One teaspoonful to a dessertspoonful four times daiJy. 

—Smith. 

Fresh air, outdoor exercise and daily bathing are necessary. 
Farm-life, sea-air and sea-bathing have been found efficacious. 
The following is a useful iodine mixture for external application: 

{fc- Liquor iodini composita 

Gly cerime — aa , Sj • — M. 

Sig.: To be applied over the gland as an inunction. 

The synovitis or strumous arthritis must be treated appropri- 
ately when it occurs. When it occurs in two or more joints, it 
may be mistaken for rheumatism (Loomis aud Smith). 



SCURVY. 507 

SCURVY. 

Called also scorbutus, is a chronic blood disease, which may 
be regarded as a peculiar form of anaemia arising from deficiency 
of vegetable diet. This disease appears to have been known to 
the ancients. During the last iive or six centuries it prevailed 
very entensively in armies and among crews of sailing vessels, 
and hence it was called sea- scurvy. It prevailed enormously in 
the English and French armies in the Crimean War, and also in 
the late Civil War in our own country (Flint and Loomis). 

Causes. — Deprivation of fresh vegetable food for along time 
will very surely induce scurvy. It is rarely met with from any 
other cause, although an unvaried diet of poor quality may in- 
duce it (Loomis). 

Symptoms. — The skin of the face and eyelids changes color 
and appears bruised and swollen. The pulse is soft and the 
temperature lower than normal. There is great despondency 
and a sense of weight in the lower limbs. The skin is dry, rough 
and of a muddy pallor. The conjunctivae are pearly white, the 
tongue is clean and pale, the teeth loosen and are surrounded by 
bright red ulcerated and spongy gums which bleed upon the 
slightest provocation. The breath is exceedingly offensive, fre- 
quently from necrosis of the jaws. Ecchymoses and petechial 
spots cover the body. Severe darting pains are felt in the limbs, 
about the calf of the leg and the popliteal space. Node-like 
swellings occur over the tibia. Slight exertion may occasion 
palpitation, dyspnoea, and even syncope (Flint and Loomis). 

Differential Diagnosis. — Scurvy may be mistaken for mercy/r- 
ial poisoning and pwpwd. The history of the case and a close 
inspection of the gums will enable one to distinguish scurvy 
from mercurial poisoning. Scurvy is distinguished from pur- 
pura by the spongy gums, painful swellings, and more profuse 
though less numerous hemorrhages. Purpura is not affected by 
lime juice, or change in diet, while scurvy is (Loomis). 

Prognosis. — Scurvy is not a fatal disease, if uncomplicated, 
and appropriate treatment applied. It Avas the cause of death 
in a large proportion of those who died during the potato 
famine in Ireland (Loomis). 



508 A COMPENDIUM OF PRACTICAL MEDICINE. 

Treatment. — In long sea- voyages or campaigns lemon or 
lime juice or citric acid should be taken daily when fresh or pre- 
served vegetables cannot be obtained. By their use in the 
English navy, scurvy has been diminished nearly ninety per 
cent. Orange -juice is also an effectual antiscorbutic. One of 
the most efficient of antiscorbutic vegetables is the potato. It is 
most efficient when eaten raw. Pickles, onions, raw cabbage or 
sauerkraut, the water- cress, green corn and green apples are 
valuable antiscorbutics. One who is seriously ill of scurvy 
should be kept in bed, and his diet should be fresh vegetables 
and acid fruits with fresh meats. Three or four ounces of lime 
or lemon juice largely diluted with cold water should be taken 
daily. Tincture of the chloride of iron and ergot are given to 
arrest hemorrhage. Whiskey may be given when indicated. To 
arrest local hemorrhage, alum, tannin, subsulphate of iron and 
the chloride of iron are most useful. A wash of chlorate of 
potash will afford relief to the mouth symptoms. Quinine, iron 
and strychnine act both as tonics and appetizers (Flint and 
Loomis). 

SEA=SICKNESS. 

Is a peculiar form of functional disturbance of the nervous 
system characterized by severe depression and persistent nausea 
and vomiting (Loomis). , 

Causes. — Sea-sickness is most commonly the result of the 
motion of a ship, but it may be the result of any unusual 
motions to which the person is unaccustomed, as the motion of a 
swing or an elevator. Waltzing, riding backwards, turning a 
somersault, or the sudden jerk of a railroad train as it starts or 
stops may each produce a similar condition. In some persons, a 
mild form of sickness may be produced by simply watching 
oscillating objects. Some persons never suffer, while others are 
unable to endure the slightest motion on the water or elsewhere. 
The nerve centres are embarrassed, and the resulting nervous 
irritation manifests itself through vaso-motor disturbances in 
precisely the same manner as is seen when persons blush under 
embarrassing circumstances, or pale when startled (Loomis). 



SEA- SICKNESS. 509 

Symptoms. — Seasickness usually presents the two stages of 
first, depression and exhaustion, and second, reaction. It begins 
with a sense of weight and epigastric oppression, occuring only 
during the rapid rise and fall of the vessel. It speedily becomes 
continuous and is accompanied by vertigo and headache. Nausea 
is always most intense and at the same time the vomiting is often 
sudden and projectile, as in cerebral vomiting. The appetite is 
entirely lost. The mental depression is great. In the majority 
of cases this condition continues from three to five days, provided 
the voyage is of that length during which time the nausea, vomit- 
ing and mental depression continue and is then followed by reac- 
tion. There is now a ravenous appetite and a feeling of well being. 
In some cases the stage of depression lasts for weeks, and the pa- 
tient may pass into a stage of partial collapse and coma 
(Loomis). 

Prognosis. — It is very rarely fatal, but occasionally a condi- 
tion of collapse develops which, if not assiduously treated, may 
pass into coma and death (Loomis). 

Treatment. — For the vaso-motor disturbance and spinal con- 
gestion, counter -irritation to the spine, or ice-bags and the bro- 
mides and nitrite of amyl have proved the most useful. The ice- 
bag controls the spinal congestion. The bromides must be be- 
gun some time before the voyage and continued in large doses 
until the patient is accustomed to the motion. Amyl nitrite 
seems to be the most efficacious remedy yet proposed. It should 
be given in full doses upon the first appearance of epigastric dis- 
tress and repeated as necessary. Dr. Clapham reports 121 suc- 
cessful cases out of a total of 124 in which amyl nitrite was used. 
Sometimes stimulants are effective but often fail (Loomis). Ac- 
cording to Bartholow sea- sickness is relieved sometimes by the 
subcutaneous injection of atropine in small quantity. A little 
chloroform (2ftii-2T£v.) dropped on sugar and swallowed is some- 
times effective in sea- sickness. Chloral in fifteen to thirty grain 
doses every four hours, is probably the most effective remedy, 
but it must be given before decided nausea sets in. The bromide 
of sodium in half to one drachm doses before embarking is one 
of the first remedies in sea-sickness. Nitro- glycerine by the 
stomach may afford relief (Bartholow). 



510 A COMPENDIUM OF PRACTICAL MEDICINE. 

SEPTICEMIA. 

Is a constitutional disease due to the absorption into the 
blood of a septic material which is developed in decomposing 
animal matter by the action of putrefactive bacteria. The dis- 
ease is closely allied to surgical or traumatic fever (Loomis). 

Causes, — The nature of the septic poison is still a matter of 
dispute. Some claim that it is a chemical substance formed in a 
wounded part, while others regard the bacteria the sole cause of 
the septic infection. Decomposing tissues which cause septi- 
caemia may be in the body, on the surface of the body, or outside 
of the body. 

I Thus, a decomposing placenta in utero, sloughing ulcers 
in typhoid, necrotic processes in chronic phthisis, diphtheritic 
sloughs, ulcerative endocarditis, abscess and gangrene of the 
lung — these are some of the internal conditions which may induce 
septicaemia. 

II. Wounds, gangrene, decomposing membranes, or sup- 
puration and necrosis in small -pox, any ill-conditioned wound, 
especially if lacerated and contused, may cause septicaemia. 

Ill Dissecting wounds and post- mortem manipulation of 
those who have died of infection, even without a surface abra- 
sion, may induce septicaemia. The respiratory and the gastro- 
intestinal tracts are sometimes the mode of entrance of the infec- 
tion (Loomis). 

Symptoms. — The symptoms of septicaemia or blood-poison- 
ing will vary with the amount of the septic material introduced 
into the system and the length of the infection. In a well- 
marked case, after a rigor, or feeling of chilliness, but rarely a 
distinct chill, there is a rapid rise in temperature; 105° or 107° 
F. may be reached within the first twenty-four hours. The pulse 
is rapid, 120 to 140, feeble and thread-like. The mouth, tongue, 
and surface of the body become hot and dry. If sweats occur 
they are very slight. Vomiting is frequent. The countenance 
is dull, and the patient generally free from pain. There is rest- 
lessness and low muttering delirium. The respirations are feeble, 
labored, and hurried. The skin may be slightly jaundiced. 
Diarrhoea is present in nearly all severe cases. In severe cases 



SEPTICEMIA SPEKXATOKRHCEA 511 

death may occur within twenty-four to seventy-two hours, the 
patient dying in complete collapse. Typhoid symptoms, a dry 
tongue, rise in temperature, diarrhoea and muttering delirium, 
following an abortion or child-birth, should always excite sus- 
jDicion (Loomis). 

Differential Diagnosis. — Septicaemia may be mistaken for 
pycerma. Pycemia is ushered in by a distinct chill; septicaemia 
by a slight chill. In pyaemia the chills recur; in septicaemia 
there is but one chill. In pyaemia there are profuse sweats, 
which recur; in septicaemia there are slight, if any, sweatings, 
and they are never recurrent. In pyaemia the temperature grad- 
ually rises to 102° to 104° F.; in septicaemia it is high at the 
onset, 105° to 107° F. There is a sweet "sickish" odor to the 
breath in pyaemia, absent in septicaemia. Pyaemia develops 
slowly, septicaemia rapidly (Loomis). 

Prognosis, — When the symptoms of the disease are well 
marked the prognosis is bad. Its duration is from two days to 
two months. 

Treatment. — Discover and when possible remove the cause. 
Antiseptics should always be used at the seat of the infection. 
The bowels must be freely acted upon by salines throughout the 
whole course of the disease. Quinine, salicylic acid and brandy 
are the three drugs on which we place our reliance. Tanner 
recommends quinine and nitric acid. The diet must be as nour- 
ishing as possible. Billroth's treatment is cooling drinks, a fever 
diet, morphine at night to secure sleep, from six to ten grains of 
quinine during the afternoon and warm baths (Loomis). 

SPERMATORRHEA. 

Is an escape of seminal fluid containing spermatozoa, without 
ejaculation and without pleasurable orgasm, usually at stool, 
with the urine, or to a slight extent at all times. During pro- 
longed erection under intense sexual excitement, a small amount 
of true seminal fluid is apt to escape into the prostatic sinus, and 
to be passed at the next urination. This may happen to any one 
occasionally, and does not amount to disease (Keyes ). 



512 A COMPENDIUM OF PEACTICAL MEDICINE. 

Varieties. — /. True Spermatorrhea. II. False Sper- 
matorrhoea. 

True spermatorrhoea may exist, but it is a very rare disease. 
It falls to the lot even of the specialist to see but very few cases 
of true spermatorrlicea. 

False spermatorrhoea, is, however, a more common com- 
plaint. It is supposed to be present when nocturnal emissions 
are frequent, when diurnal emissions* take place on any sexual 
thought, and urethral discharge of a glairy fluid attends defeca- 
tion, when erections with discharge follow the slightest irritation, 
such as that produced by riding or walking, from the friction of 
trousers, etc. Such cases are common and are usually due to 
masturbation, but are not cases of true spermatorrhoea, although 
they often preceed it. Nocturnal emissions may be too frequent; 
but if associated with sexual feeling, they are natural. If 
too frequent, they should be checked as they may lead on to the 
true disease. The glairy fluid pressed out in defecation is rarely 
seminal, but is prostatic, of a transparent, tenacious character, 
and not milky. Most of the symptoms which a patient usually 
mistakes for spermatorrhoea are a gleety discharge, phosphatic 
urine, vesical mucus, decomposing urine, etc. The young man 
into whose hands some pamphlet on u Manhood Restored " has 
fallen, imagines himself hopelessly doomed to impotence, paraly- 
sis, and idiocy, because the pamphlet tells him that he has sper- 
matorrhoea, which spermatorrhoea consists in nocturnal pollution, 
escape of mucus during prolonged erection, of phosphates in the 
urine, etc. Sometimes, where the diseased mind of a youth suf- 
fering from ungratified sexual desire can find nothing else to con- 
firm its suspicions, the natural healthy flocculent cloud of mucus 
collecting normally in all urine, after it has stood awhile, is 
pointed to, in dejected triumph, as a demonstration of the never- 
ending loss of seminal fluid (Bryant and Keyes). 

Causes. — Spermatorrhoea sometimes follows excessive mas- 
turbation, general prostration, as after typhoid fever, imperfect 
digestion and general nervous distress from overwork, or other 
cause, or follow chronic disease of the prostatic sinus and seminal 
vesicles. It is sometimes associated with constipation and rectal 
irritation, spasmodic action of the levator ani acting on the 



SPERMATORRHEA. 513 

vesiculae seminales and prostate gland. The worst cases are asso- 
ciated with wasting of the testicles and varicocele. It is some- 
times due to excess of venery. Lallemand holds that sperma- 
torrhoea is nearly always dependent upon irritation of the pros- 
tate gland and its ejaculatory ducts. Trousseau believes that 
spermatorrhoea or incontinence of semen is due to some imper- 
fection in the nervous system of organic life, since it is so 
commonly found in men who have had incontinence of urine in 
childhood (Bryant and Keyes). 

Symptoms. — In true spermatorrhoea it is usual for spermatic 
fluid in small quantity to pass from the meatus during defecation 
and urination; while jolting or riding, etc., cause oozing of a 
bluish fluid from the meatus, which contain spermatozoa. Pa- 
tients with true spermatorrhoea have little care for their sexual 
functions and are not disturbed on the subject of impotence and 
present in this respect, a most strongly marked contrast with the 
hypochondriacal patients imagining themselves impotent from 
false spermatorrhoea. Patients with true spermatorrhoea are not 
by any means necessarily impotent, but their sexual appetite is 
usually morbid, excessive or feeble perhaps unnatural and per- 
verted, while sexual power is generally diminished. According to 
Bryant, spermatorrhoea commences almost always with nocturnal 
emissions which gradually become more frequent. These are at 
first attended with erotic sensation, but finally occur without 
erection. If copulation be attempted the ejaculation takes place 
at once, often before the introduction of the organ. In many 
cases the general symptoms are those of great lack of nervous 
tone, dyspepsia, headache, melancholy, neuralgia, loss of spirits, 
pains in the back, groins, testicles and vesical irritability. Such 
patients tend to grow thin, to lose their ambition and to fret. At 
last the penis shrivels, the testicles become small, flabby and very 
sensitive and the patient becomes truly impotent, incapable of 
erection. This malady does not kill. Dr. Keyes knows an old 
gentleman who enjoys excellent health and who lias had true 
spermatorrhoea more than fifty years (Bryant and Keyes). 

Treatment. — Many cases are positively incurable, some gei 
well — medicine is of little or no value. It is unfortuate that so 
many text-books ascribe value to the use of drugs in this malady. 



514 A COMPENDIUM OF PRACTICAL MEDICINE. 

All the hygienic, general and local measures advised for cases of 
pollution may be tried. The use of the steel sound helps to give 
tone to the parts. Rouband thinks well of ergot — two to eight 
grains daily — in atonic cases. The use of a local astringent to 
the prostatic sinus is often of marked advantage. The best agent 
for effecting this is nitrate of silver in solution (gr. x. to 5j to 
the ounce), three to five drops of this thrown into the deep 
urethra. Bryant thinks half-grain doses of the extract of bella- 
donna twice a day, with some tonic such as iron, zinc, strych- 
nine, or quinine, are valuable. The rectum should be kept 
empty by a nightly injection of cold water. If a positive local 
treatment, with perhaps some tonics when required, fails to cure, 
the patient will be wise to accept his malady as he would some 
deformity which others cannot see, and think as little of it as 
possible, keeping his mind pure and his thoughts away from the 
subject (Bryant and Keyes). 

STRANGURY. 

Is the painful passing of urine in drops. It is not a disease 
but a symptom. The following prescriptions have been tried 
and recommended : 

J& Tincturse cannabis indicae ^ij. 

Sig. : A half-teaspoon ful every few hours. (When strangury is 
due to spinal disease with bloody urine.) — Ringer. 

jfc Pulv. opii gr. ii.-iv. 

Olei theobromse 3j . — M. 

Ft. suppositoria no. ii. 
Sig.: Introduce one into the bowel, and repeat if necessary in 
four hours. — Hartshorne. 

STYE. 

Called also hordeolum, is a small red and painful swelling 
situated on the outer surface of the lid or near its margin, and 
consists in a circumscribed phlegmonous inflammation of the lid 
dependent on morbid change in the Meibonian glands (Bryant 
and Noyes). 

Causes. — Styes generally occur in weakly, delicate persons, 
and are apt to be associated with chronic blepharitis or conjunc- 



STYE SPINA BIFIDA. 515 

tivitis, and often depend on general debility. Another frequent 
concomitant and favoring condition is nasal catarrh, which will 
also need attention. Several styes may appear simultaneously, 
or there may be a succession of them. They give rise to con- 
siderable irritation and are often extremely painful. The 
innammation usually goes on to suppuration (Bryant and Noyes). 
Treatment. — In its inception it may sometimes be checked 
by applying a bit of ice wrapped in muslin for a few minutes 
repeatedly, or by pulling the cilium which passes through it. 
When suppuration is unavoidable, a poultice of ground slippery 
elm bark is most comforting, and a puncture should be made at 
an early period. Good living, general tonics, and mild astrin- 
gents are the proper remedies to prevent their recurrence; but it 
is important also to investigate the state of refraction, because 
what causes eye strain will provoke styes (Noyes). The follow 
ing lotion may be of service: 

Jfc Acidi boraeici ^iss. 

Aquae destillatee , 5V. — M. 

Sig. : Apply to the eyelids several times daily. — Abadie. 

SPINA BIFIDA. 

Called also hydrorachitis, is a congenital defect of the ver- 
tebral column, accompanied by a protrusion of the surroundino* 
membranes of the cord, due to an arrest of ossification of the 
vertebrae of the foetus at this point. It is essentially a congenital 
hernia of the membranes of the cord through an opening iu the 
spine. It is analogous to the meningoceles of the cranium, and 
is similar in nature to hare -lip and cleft palate. The liquid in 
hydrorachitis is simply a portion of the cerebro- spinal fluid 
which normally exists in the subarachnoid space in the brain and 
spinal cord. It often contains the spinal cord itself or large 
nerve trunks (Bryant and Sayre). 

Characters of the Tumors. — The spinal hernia is sometimes 
covered by the whole thickness of integument; at others the in- 
tegument, though present, is very thin; while occasionally the 
walls are represented only by a transparent membrane. The 
tumor may have a broad base and free communication with the 



516 A COMPENDIUM OF PRACTICAL MEDICINE. 

central canal of the cord, or a narrow and more or less peduncu- 
lated one. The cord is more likely to be involved in the greater 
than in the less base. The tumor is always more or less globu- 
lar, tense and elastic. When the child is asleep or quiet the 
swelling may be soft; but when the child cries the tumor will 
rapidly fill out. The skin of the tumor may be ulcerated at 
birth or have a small opening (Bryant). 

Associated with Hydrocephalus . — The tumor is often asso- 
ciated with hydrocephalus and in exceptional instances is double. 
A nwvuB is not seldom found situated over the tumor. Club- 
foot ox paralysis of the lower limbs frequently co- exist with it, 
and in these cases it is tolerably certain that the cord is included 
in the hernia. Paralytic symptoms are more common in the 
broad- based hernia than in the narrow. Incontinence of urine 
or of feces may co- exist with the paralysis (Bryant). 

Situation of Tumor. — The lumbo- sacral portion of the column 
is more frequently affected than any other, but the cervical and 
dorsal portions are also liable to the defect. Of twenty -seven 
cases of Bryant's, thirteen occured in the lumbar region, four in 
the lumbo- sacral, and nine in the sacral, and one was double, a 
small tumor being in the lumbar and a large one in the sacral 
region. Twelve of these cases were uncomplicated with any 
paralysis or deformity. In eleven there was incontinence of 
urine and feces, associated in four with paralysis of the lower ex- 
tremities. Four were complicated with hydrocephalus, two with 
nsevus, and one with talipes. Bryant has seen but two cases in 
which the tumor was in the cervical region. In exceptional cases 
the spinal hernia may protrude on the anterior part of the spine. 
When the tumor is complicated with hydrocephalus "fluctuation 
may often be felt between the two parts, pressure on the head 
causing a fullness of the spinal hernia, and vice versa (Bryant). 

Diagnosis. — In general, there is no difficulty in diagnosing a 
spina bifida. In any infant a congenital tumor over the spine 
is probably a spina bifida; if globular and tense or capable of 
becoming tense when the child cries, the probabilities are almost 
converted into a certainty. The only cases for which spina bifida 
is liable to be mistaken are congenital tumors, unconnected with 
, the spine, such as cystic, fibrous, fatty or fcetal tumors. These 



SPI^A BIFIDA. 517 

may be hard and tense, but they are rarely, if ever, made so 
much more tense from the child crying, as is the spinal hernia 
(Bryant). 

Prognosis. — The majority of these cases prove fatal. Many 
of the subjects are ill -developed and die within a few days of 
birth; death from convulsions is very usual when the sac bursts 
and its fluid contents escape, more particularly when the escape 
is rapid. The rupture of the sac is not necessarily followed by a 
fatal result. Bryant had a case in which at birth the tumor was 
transparent and soon burst, and subsequently discharged at inter- 
vals for three years, and finally contracted up into a solid mass. 
This case is an example of a natural cure by gradual closure of 
the bony orifice. The more pedunculated the tumor the better 
the prognosis (Bryant). 

Treatment. — The treatment of these cases is very unsatisfac- 
tory. In the majority of cases, palliative treatment is all that 
can be adopted; although in exceptional instances operative 
interference promises to be of service. The tumor must always 
be guarded from injury by some soft protective material. Slight 
pressure to prevent rapid increase of the tumor is always bene- 
ficial. The application of collodion is sometimes useful. Aspira- 
tion, subcutaneous puncture with a trocar, and injection of the 
iodo- glycerine solution have been practiced with more or less 
success. Successful cases are recorded in which tapping of the 
hernia has been performed. The practice is dangerous, as the 
drawing off of the fluid has been followed by convulsions and 
even death; yet it is the least dangerous form of practice, and may 
be undertaken. The puncture should always be made at the side 
of the tumor, and the whole of the fluid should never be drawn 
off at once. 

Mr. W. E. Image, of Bury St. Edmund's, cured a case by 
puncture with a darning-needle at intervals of two or three days, 
four or six times, and applied a compress. In this case con- 
vulsions were produced whenever any pressure was applied to 
the tumor, but ceased after tapping. Dr. Morton, of Glasgow, 
has advocated the injection at intervals of seven or ten days of 
half a drachm of a solution made by dissolving ten grains of 
iodine and thirty grains of iodide of potassium in an ounce of 



518 A COMPENDIUM OF PRACTICAL MEDICINE. 

glycerine. The injection should be thrown into the sac after the 
withdrawal of a small portion of the spinal fluid. Dr. Morton 
reports, in 1881, that out of twenty-nine cases operated upon, 
there were but six failures. This success is encouraging*. In a 
case of Bryant's, after the second tapping, there was so much 
draining of the fluid from the cord that the child died from ex- 
haustion. 

In no case where the base or neck of the tumor is large or 
the cord involved should this or any other operation be per- 
formed. In pedunculated tumors an operation may be attempt- 
ed. In the case of a tumor with a small pedicle Dr. Sayre ligated 
the base of the sac with success. He passed a needle armed with 
a double ligature through the centre of the pedicle and after 
tying one ligature on each side, passed two circles entirely 
around the pedicle, drawing them so tight as to strangulate the 
mass and then excised it with one stroke of the knife. On the 
twenty -third day the ligatures came away leaving the wound 
entirely healed. Dr. Wilson, of Clay Cross, reports a successful 
case in which he removed the tumor five days after the closure 
of its neck by means of a clamp. In some cases of spina bifida 
nature effects a more or less perfect cure by closing in the defec- 
tive portion of the spinal canal. The child should be fed upon 
the most nutritious diet with the administration of the j3hos- 
phates, lime, etc. (Bryant and Sayre). 

SPRAINS. 

May be very slight or very serious indirect injuries. They 
include more or less severe overstretchings, if not lacerations of 
the muscles or ligaments that bind the bones of an articulation 
together, some fracture or tearing away of the bone at the attach - 
meut of the ligaments — "sprain fractures," In children under 
ten, sprains of joints are liable to be complicated with some 
epiphysial separation. In the more severe instances are included 
lacerations of the muscles, tendons, and soft parts that surround 
the joint. All such accidents require rest and time in their treat- 
ment in order that repair may be complete, since neglected 
sprains arc often the cause of joint or bone disease (Bryant). 



SPRAINS. 519 

Contusions of joints as direct injuries always ought to be 
regarded in a serious aspect, for a large amount of internal mis- 
chief may often be sustained with very slight external evidence 
of injury. Under certain conditions of health a slight blow 
upon a bone is often enough to set up severe local action or to 
excite chronic changes which may involve the integrity of the 
joint (Bryant). 

Sprain of the hack is an accident of common occurrence. 
Any twist of the spine or forcible flexion may injure some of the 
joints. Hemorrhage may take place into the spinal canal as a 
result of the sprain or laceration of the ligaments. 

Prognosis. — Sprains may be followed by acute or chronic 
joint disease of a serious and insidious nature; and this truth 
should ever be before the surgeon to influence his practice. In 
every case of wounded joint, however trivial, aud in all doubtful 
cases of wounded joint, the prognosis must be very guarded and 
the treatment cautious (Bryant). 

Treatment. — About one hundred years ago John Hunter 
said: u In sprcvms of joints rest is the first principle" At the 
present day the same words are as pregnant with truth as when 
then spoken. In simple cases of sprain rest is all that is needed. 
When swelling and effusion into the joint ensue in the course of 
the second or third day after the accident, the evidence of inter- 
nal injury is more marked, for such effusion means inflammation 
or synovitis, which is to be treated by absolute rest, ensured by 
the application of a splint, and the local use of cold or warmth. 
If swelling of the articulation follows immediately upon the 
injury, effusion of blood into the joint is indicated with or with- 
out fracture, but always with severe local mischief. Such cases 
should be treated by the employment of a splint, to ensure im- 
mobility of the joint, elevation of the injured part, and local ap- 
plication of a bag of pounded ice until hemorrhage lias ceased, 
and all risks of inflammation of the joint are gone. As soon as 
the primary effects of the sprain and all signs of inflammation 
have passed, the application of pressure to the joint by means of 
a bandage with passive movement is very striking. When the 
joint is rendered very tense from effused blood, it may be aspir- 
ated. In children all falls upon the hip followed by pain should 



520 A COMPENDIUM OF PRACTICAL MEDICINE. 

be treated by rest and extreme care, as hip disease may originate 
from such cause (Bryant). 

After Treatment. — When the immediate effects of the sprain 
have passed away the local use of a stimulating liniment and 
moderate friction of the part expedites the cure. A local warm 
bath at intervals likewise relieves the stiffness of the joint. 
Whenever movement excites more than a momentary pain, rest 
should be observed. When weakness of the joint alone remains, 
a good bandage or strapping around the part to give support is 
of great benefit. Where much laceration of ligament has taken 
place it is necessary for the joint to have some artificial support 
in the form of either a splint, felt, leather casing or bandage; 
for no parts are repaired with less permanent power than liga- 
ments. In the wrist when much swelling exists, a sprain maybe 
mistaken for a fracture or a fracture for a sprain. Much care is 
necessary in the diagnosis of such cases. Many sprains of the 
ankle are also really cases of fracture of the fibula above the 
malleolus. The popular notion that a severe sprain is worse than a 
fracture is in the main true; and when the sprain is neglected 
the case is always more tedious than that of a broken bone 
(Bryant). 

STRICTURE OF THE URETHRA. 

An unnatural narrowness of any portion of the canal of the 
urethra constitutes stricture. This contraction of the canal to 
constitute stricture must be unnatural, for the urethra has 
certain points of normal contraction — namely, the meatus, the 
middle of the pendulous, and the beginning of the membranous 
urethra, and these are not strictures. They become so, if they 
are unduly small. Thus, an individual may have a congenital 
stricture of the meatus. Any inflammatory condition of the walls 
of the canal, or spasmodic contraction of the same, constitutes 
stricture, as does also any growth upon or beneath the mucous 
membrane, as cancerous, tubercular, syphilitic and membranous 
(Keyes). 

Varieties of Stricture. — Stricture is of two kinds : 1. Mus- 
cular, or spasmodic. 2. Permanent, or organic — the latter may 
be congenital, or acquired. Inflammatory stricture does not 



STRICTURE OF THE URETHRA. 521 

exist as a disease of the urethra. Xo amount of simple inflam- 
mation of the urethra would occasion serious inconvenience 
(retention \ unless occurring in connection with organic stric- 
ture, assisted by muscular spasm or complicated by prostatic 
congestion. 

I. Muscular or Spasmodic Strict are. — -Is of the commonest 
occurrence; an active predisposing cause is a sensitive, high- 
strung nervous organization. The exciting causes are any local 
irritation, inflammation, foreign body, irritation of the rectum, 
(reflex action), ingestion of certain substances, as cantharides, 
turpentine, quinine, opium, etc.. mental emotions, and malaria. 
Take a nervous, excitable young man with a healthy urethra, or 
better still with an irritable bladder or inflamed urethra, and 
attempt to pass a bougie for the first time, and the chances are 
that it will be arrested. It may be grasped and firmly held at' 
any part of the canal, but this is more liable to occur just as the 
instrument is entering the membranous urethra, where its point 
may be detained for manv minutes by an involuntary contraction 
of the cut -off muscles. If the end of the sound is held quietly 
for a few moments against the contracting muscle, the spasm will 
yield, and the instrument pass on into the bladder. 

What surgeon has not witnessed spasmodic stricture, caused 
by modesty, shame, anxiety, fear, and irritated mind, as shown 
by the total inability of some patients to pass water before a 
class of students or even in the presence of a physician alone in 
his office \ In such cases there is a failure of the compressor 
urethra? to relax. The patient contracts his abdominal muscles 
and his diaphragm, and uses all his will, but to no purpose. 
There are two cases on record of malarial spasm where sj)asinodic 
stricture occurred paroxysmally every twenty-four or forty - 
eight hours, and was cured by quinine after other means had 
failed. 

Irritation and reflex action of neighboring parts, as inflamed 
hemorrhoids, ulcer or worms may cause spasmodic stricture and 
retention. Thompson gives a case where all the symptoms of 
stricture existed, and where a diagnosis of stricture of the mem- 
branous urethra was made, when it was discovered that the 
patient had tapeworm. After the worm had been discharged, 



522 A COMPENDIUM OF PRACTICAL MEDICINE. 

the stricture disappeared. Necrosed coccyx and abscess of the 
right seminal A^esicle have caused spasmodic stricture. Keyes 
saw complete retention from one application of the tincture of 
delphinium to the scrotum to destroy pediculi. Remote surgical 
lesions may occasion retention by reflex spasmodic stricture. Dr. 
Davenport records the case of an old man who had all the evi- 
dences of permanent deep urethral obstruction for ten years, and 
who was relieved at once and permanently by a single passage 
of a silver catheter. Keyes has met a large number of cases in 
which reflex spasmodic stricture was caused by a decidedly 
narrow meatus, by a very moderate organic stricture, by changes 
in the seminal vesicles, prostate, bladder, kidney, and strongly 
concentrated acid urine (Keyes). 

Diagnosis. — Spasmodic stricture always occurs suddenly, the 
stream of urine between the paroxysms being of normal size. It 
is occasionally continuous, and acts exactly like organic stricture 
(Keyes). 

Treatment. — Discover and remove the cause. Retention pro- 
duced by simple spasm can often be relieved by the hot bath, 
rest, an opiate, and ice in the rectum, or at once by an anaesthetic 
and the catheter (Keyes). 

II. Permanent or Organic Stricture. — If not congenital, 
is the result of a previous pathological process. 

Form of Stricture. — 1. Linear. 2. Annular. 3. Tortuous. 
A linear stricture is like what would be caused if a thread were 
tied around the canal; or it may consist of a thin membranous 
diaphragm, with its orifice at the centre or on one side; or be a 
crescentic fold or free band. An annular stricture is broader, 
as if a flat tape had been tied around the canal. Tortuous stric- 
tures include all other varieties. They may be an inch or more 
long. The amount of contraction in stricture varies from a slight 
narrowing to nearly absolute occlusion (Keyes). 

Number of Strictures. — Stricture is usually single; but 
Thompson found in a single urethra, four; Hunter, six; Lalle- 
mand, seven; Colot, eight; and Otis fourteen (Keyes). 

Seat of Stricture. — The urethra is divided into three regions: 
Region one, the bulbo-membranous, contained 215 strictures out 
of a total of 320, or 67 per cent.; region two, the middle portion, 



STKICTITRE OF THE URETHRA. 523 

contained 51 strictures, or 16 per cent.; region three, the first two 
and one-half inches of the canal from the meatus, contained 54, 
or 17 per cent. (Thompson). Otis places a majority of all stric- 
tures within the first one and one-quarter inch from the meatus; 
next the middle portion, and the least number in the deep 
urethra (Keyes). 

The Lesion in Stricture. — May be a mere thickening of the 
mucous membrane, the surface having lost its polish, being con- 
gested and perhaps covered with granulations. These changes 
are the result of chronic inflammation. This process takes place 
just within and beneath the mucous membrane. If the stricture 
is extensive and far advanced there will be a mass of dense, 
fibrous callous material encircling the canal and holding it per- 
manently contracted. This tissue may be slight in extent, cicatri- 
cial in character and tightly contracted, or it may be exuberant, 
knobbed and excessive in amount so that it may be readily felt 
from the outside of the canal, having a cartilaginous or even 
w^oody hardness (Keyes). 

Causes of Stricture. — Omitting congenital and other varieties 
of stricture already alluded to (cancerous, etc.) organic stricture 
is always caused by inflammation or a traumatism. Inflamma- 
tion of the urethra is the most common cause, whether this be sim- 
ple urethritis or gonorrhoea. Of 220 cases of stricture studied 
critically by Thompson 164 (seventy- five per cent.) owed their 
origin to gonorrhoea. The longer the duration of a given gon- 
orrhoea the more certain it is to be followed by stricture. This 
is almost surely the case where gonorrhoea prolongs itself in- 
definitely in the gleety stage, the latter condition being nearly 
conclusive proof of forming stricture. Gonorrhoea attended by 
chordee is more apt to be followed by stricture than otherwise. 
Should the chordee be "broken, 11 stricture becomes inevitable 
and that too of the traumatic sort. The new fibroid and cicatri- 
cial tissue has a tendency to contract more and more. Traumatic 
stricture may be produced by falling astraddle a beam, chair, 
stump, fence or wheel, or a kick in the perinaeum from man or 
beast. 

The only treatment of gonorrhoea which may cause stricture 
is the use of injections. The nozzle of a syringe, if long or 



524 A COMPENDIUM OF PRACTICAL MEDICINE. 

roughly used against an inflamed mucous membrane, may irritate 
it sufficiently to keep up local inflammation, until it becomes 
chronic, and passes on to that cell -proliferation and thickening 
which constitute stricture. Too strong injections may cause strict- 
ure, usually situated from two to four inches down the canal, 
rarely lower. As a general rule, it may be stated that any in- 
jection strong enough to produce either blood or subsequent 
prolonged pain, is capable also of originating organic stricture 
(Keyes). 

Time of Occurrence of Stricture after Gonorrhoea and In- 
jury. — Of the one hundred and sixty-four cases of stricture fol- 
lowing gonorrhoea, tabulated by Thompson, in ten, symptoms 
appeared immediately after or during the attack; seventy -one 
within one year; forty- one, between three and four years; twenty - 
two, between seven and eight years; twenty, between eight and 
twenty-five years. J. D. Hill makes the shortest period of strict- 
ure after gonorrhoea two years; longest, thirteen years; after in- 
jury, shortest period four months, longest, eighteen months. 
Boys have been kicked at school or have fallen on a fence, and 
symptoms of stricture did not occur for ten or twelve }~ears after 
(Keyes). 

Irritable and JResilient Strictures. — A stricture is said to be 
irritable when it is very sensitive. A resilient stricture is one 
which is elastic, contracting quickly after being dilated (Keyes). 

Diagnosis. — Organic stricture of the urethra is easy of diag- 
nosis. In exploring a given urethra for the first time for 
stricture, Keyes prefers to use a blunt steel sound which will 
just pass the meatus. The blunt sound causes less pain than 
either the bulbous bougie or the urethrameter. It should be 
warmed, lubricated, and introduced with all gentleness. If it is 
obstructed anywhere, there is stricture, for the meatus is nor- 
mally the smallest part of the canal. When an obstruction is 
encountered, a smaller blunt sound is selected, and then another, 
until some sound will enter the bladder. It is always well in 
searching for stricture to commence with a large size and work 
down rather than to begin with a small instrument. 

Keyes has had cases referred to him, as cases in which a 
filiform instrument could not be made to enter the bladder, and 



STEICTUEE OF THE UEETHEA. 525 

he lias at once passed a full- sized blunt steel sound easily into 
the bladder. The explanation of this is that spasm of the deep 
urethra frequently fails to allow a fine instrument to pass, while 
spasm in that region always yields to gentle pressure slowly and 
accurately applied with a blunt steel sound. Moreover, a false 
passage, or a pouched sinus, or a dilated follicle, will frequently 
catch the point of a fine instrument, while a blunt sound will 
escape the obstacle. Having detected stricture, it may be 
located, calibrated and measured either with a metallic bulbous 
bougie or the urethrameter in the anterior urethra, or with a 
flexible bulbous bougie in the deep urethra. Obstructions 
beyond six and a half inches may generally be set down as due 
to prostatic enlargement, particularly in patients older than fifty 
years. 

There is a point of physiological narrowing at about the 
middle of the pendulous urethra, which is by some regarded as 
a stricture requiring treatment by cutting, when there is no real 
occasion for the operation. If this point be covered by granula- 
tions, and bleeds as the bulb passes it, it is in a morbid condi- 
tion, and may require cutting, although no true stricture exists 
at the point. These are the so-called strictures of large caliber 
so popular at the present day, so common in occurrence, a rich 
field for the young surgeon, and sometimes the occasion of un- 
necessary cutting, for the gleet they occasion may often be 
removed permanently by a few passages of a large sound. Just 
within the meatus — at an eighth to a quarter of an inch — there 
is very often a point of congenital narrowing which may be 
assumed to be a stricture, and cut if there is any occasion for 
using an instrument larger than this point of narrowing will 
admit. It is always wise to divide it if stricture exists beyond. 
Always when there is a pouched condition of the meatus at the 
lower commissure, it should be cleanly and freely cut down upon 
the floor of the urethra (Keyes). 

Symptoms and Results of Stricture. — Stricture may exist for 
years without giving rise to a single symptom of sufficient im- 
portance to attract the patient's attention. In fact, it may be 
said that stricture has no symptoms until it has become so tight 
as to sensibly obstruct the outflow of urine and semen. 



526 A COMPENDIUM OF PRACTICAL MEDICINE. 

The symptoms usually described as those of stricture are 
mainly the symptoms of the results of stricture. A certain small 
amount of gleety discharge from the congested, or it may be 
granular surface usually accompanies the forming stage of strict- 
ure but this may be so slight as not to attract attention or may 
be entirely absent. Exceptionally urethral or other neuralgia 
depends upon stricture in the forming stage. 

The results of stricture are mainly mechanical. The strict- 
ured portion acts like a dam, and the urine coming down with 
great force tends to dilate the urethra behind it. If more than 
one stricture exists the urethra may be dilated between them. 
This forcible stretching of the mucous membrane behind the 
stricture at every act of micturition weakens the tone of the 
stretched portion of the canal, congests it, and leads to the for- 
mation locally of an excess of mucus. Soon a drop of urine is 
retained behind the stricture in the dilated portion of the canal, 
the mucus acting upon it as a ferment alkalinizes and decom- 
poses it, liberating carbonate of ammonia. This acts upon the 
stretched urethra, and produces inflammation. This mild in- 
flammation behind stricture is very constant. It furnishes the 
gleety discharge or the morning drop of muco-pus, which glues 
the lips of the meatus together. 

The gleet of stricture gets better or worse according to the 
general condition of the patient, the degree of acidity of the 
urine, and the amount of sexual indulgence or venereal excite- 
ment. Exacerbations of gleet from slight causes often constitute 
the most marked feature of the case in a patient with stricture. 
In fact, it is the rule in mild cases that the patient is wholly un- 
conscious that his urethra is at all narrowed. He applies for 
treatment, on account of his gleet, and often refuses to believe that 
he has stricture, and he repeatedly asserts that he makes as large 
a stream of urine as ever. Nothing so well as the bulbous bougie 
will convince such a patient of his condition. The gleety dis- 
charge, once commenced behind the stricture, rarely ceases en- 
tirely until the constriction has been relieved. The same dis- 
charge will be seen in the urine in the shape of small stringy 
shreds, formed of pus -corpuscles, and appear as small white 
threads in the voided urine. These shreds may be all caught in 



STRICTURE OF THE URETHRA. 527 

the first gush of urine, what follows being perfectly free from 
them. When these white filaments are seen settling clown in a 
glass of urine freshly passed, they constitute strong presumptive 
evidence of the existence of stricture; they may he due to other 
lesions. As the stricture tightens, a cartilaginous hardness may 
often be felt from the outside of the urethra at the constricted point. 
The meatus urinarius looks blue and congested, as does some- 
times the whole glans penis, from obstructed circulation. The 
gleet continues, the stream of urine is small, often forked. The 
last few drops of urine are retained in the canal. Erection is 
sometimes rendered imperfect and painful. 

The surface congestion of the stretched urethra behind the 
stricture in time extends backward to the bladder, and brings on 
irritability of that organ. The intervals between the acts of 
micturition grow shorter and shorter, and symptoms of mild 
cystitis appear. This frequency of micturition is the symptom 
of stricture, next to gleety discharge, which is least often absent. 
A slight narrowing of the canal may occasion it. The conges- 
tion of the urethra behind a stricture easily becomes greater, is 
kindled into positive inflammation by dining out, a little excess 
in drink, or a chilling of the legs; the mucous membrane swells 
up, the stricture closes, and the patient has retention of urine. 
If this retention is unrelieved, the bladder becomes over- dis- 
tended and the contractile power of the bladder may be perma- 
nently injured. Retention maybe the onlg disagreeably promi- 
nent symptom connected with a case of stricture. The spasm and 
inflammation which caused the narrow canal to become oblite- 
rated in these cases, cease after a few hours, and then the patient 
goes on perhaps for a year or more, without having another 
retention, not suffering noticeably in the meantime. 

If retention does not come on, the inflammation, once 
aroused behind the stricture, travels back through the prostatic 
urethra into the bladder, and we have cystitis of the neck. Now 
commences a frequent desire to pass water, and when the patient 
seeks relief, he may be passing water in a fine stream every half- 
hour with great pain and straining. Hcematuria may be, excep- 
tionally, the most prominent symptom of stricture. Keyes has 



528 A COMPENDIUM OF PRACTICAL MEDICINE. 

had several such cases, and has seen the hematuria cease upon 
relieving the stricture. 

Along with symptoms of vesical irritation, are found pains 
in the urethra, aching of the glans penis, or in the testicle, along 
the cord running up into the back, pains across the lumbar 
region, in the peringeum, around the anus, over the pubis, in the 
thighs, legs, sole of the foot, or in the great toe, all of which 
pains are cured by the dilatation of the stricture. The sexual 
appetite is often impaired, sometimes nearly obliterated, in old 
severe cases. But in mild cases, the congestion kept up behind 
the stricture may be just enough to excite and irritate the 
patient, causing frequent erections, erotic fancies, and nocturnal 
emissions. The constant straining in urination may cause piles. 
The inflammation of the bladder caused by stricture is usually 
superficial, and the bladder walls, as a rule, thicken and contract, 
but rarely dilate. The ureters enlarge in connection with old 
stricture, also the pelvis of the kidney. It may bring on abscess 
of the kidney (Keyes). 

Extravasation. — The thinned and inflamed urethra behind 
the stricture may ulcerate and during one of the violent parox 
ysms of straining give way and allow a little urine to escape into 
the cellular tissue around the canal. If the amount of urine 
extra vasated is small we have abscess or perhaps blind internal 
fistula. Its presence is indicated by a hard lump around the 
urethra from the size of a pea to that of a walnut. Urethral fe- 
ver comes on, generally described by the patient as "dumb 
ague;" the appetite fails and the general health runs down, 
finally pus forms and finds its way out through the perinseurn, 
leaving a fistula behind. If the quantity of urine which escapes 
is a little larger acute perineal abscess forms. The pus may bur- 
row in all directions and find an exit through the scrotum along 
the body of the penis, upon the thighs, nates or groins, or even 
upon the lower part of the abdomen. Sometimes the whole 
porinseum is riddled with holes through which the urine escapes. 
Civiale reports a case of urinary fistula with fifty-two external 
openings. Fistula will not close until after the stricture has 
been relieved. Extravasated urine should be let out as soon as 
possible. Normal urine does not possess septic qualities but 



STKICTUEE OF THE UKETHKA. 529 

ammoniacal and putrid decomposing urine is deadly in its effect 
(Keyes). 

Complications of Stricture. — Infiltration of urine is a serious 
complication. Rupture of the bladder is a rare complication of 
stricture. A comparatively healthy bladder will not rupture 
from retention. It will become immensely distended and then 
be relieved by drops (overflow) through the urethra. 

Epididymitis is a very common complication of stricture. 
It may affect one or both sides, and leaves behind a good deal of 
knotty induration, which is slow in disappearing, and may block 
up the canal and entail subsequent sterility (Keyes). 

Constitutional Disturbance. — A patient with very tight stric- 
ture may enjoy robust health. But when the urethra behind a 
stricture begins to inflame, and the bladder to show symptoms 
of congestion of the neck, and cystitis; when paroxysms of 
urethral fever become frequent; when epididymitis and abscess 
come on, then the whole organism shows signs of distress. The 
appetite and strength fail, the skin becomes dry, pale and harsh, 
the mouth coated and shiny, and the patient runs down to a 
shadow, a living picture of misery, while his main business in 
life is to pass water (Keyes). 

Causes of Death in Stricture Cases. — Are three: 

1. Extravasation of urine] which, if extensive kills at once 
by shock, or later by exhaustion and blood-poisoning with sup- 
puration, abscess, gangrene and pyaemia. 

2. Uraemia, from implication of the kidneys, by the exten- 
sion of inflammation up the ureters. 

3. Cachexia and exhaustion (Keyes). 

Recapitulation of Symptoms of Stricture. — Briefly the 
symptoms of stricture are narrowing of the canal, with dilata- 
tion of the urethra behind, blueness of the meatus, irregularities 
in the stream of urine, shreds of pus-corpuscles in the urine: 
pain, neuralgia of the urethra, retention of urine, overflow, 
dribbling, imperfect erection, irritability of the bladder, haeina- 
turia, and impotence. The remoter results of stricture are 
cvstitis with changes in the bladder, ureters, kidneys and rectum 
often terminating fatally, and stone in the bladder, infiltration. 



530 A COMPENDIUM OF PRACTICAL MEDICINE. 

perineal abscess, fistula, rupture of the bladder, epididymitis, and 
sterility (Keyes). 

Sexual Hygiene. — An unmarried man frequently tortures 
himself with fancied ailments, which he ascribes to stricture. He 
declares himself strictured when the canal is sound. Fancied 
stricture, next to fancied spermatorrhoea, is a very common hypo- 
chondriacal expression of perverted sexuality. The trouble is in 
the mind. These patients must be put right about the cause of 
their troubles, and their sexual hygiene must be regulated. This 
can be accomplished only by marriage or by purity of thought 
and absolute continence (Keyes). 

Treatment. — May be considered under three heads: 

1. Treatment of Uncomplicated Stricture.-— (a) Of large 
caliber; (/>) of small caliber; (<?) of the meatus; (d) traumatic; 
(e) resilient — often irritable. 

2. Treatment of Stricture complicated by — (a) False pas- 
sage; (b) retention; (<?) retention — the stricture being impassa- 
ble; (d) infiltration; (e) abscess; (f) fistula; (g) pericystitis; 
(A) enlarged prostate. 

3. Treatment of Fistula with Loss of Substance. — ($) Of 
large caliber. — The majority of strictures which the surgeon is 
called upon to treat are of large caliber. The symptom of which 
the patient complains is persistent gleet following gonorrhoea, or 
bastard gonorrhoea, with, possibly, some frequency in urination. 
In these cases the gleet is treated, and the stricture overlooked. 
The urethra should be explored, in such cases of gleet, with the 
bulbous bougie. One, two or more strictures are found. The 
chances of urethral chill, after first examinations, must be remem- 
bered. Being instructed not to mind the smarting at his next 
urination, and given an alkali, the patient is dismissed to return 
in two days, to have his treatment commenced. The treatment 
which generally gives satisfaction in a majority of these cases is 
dilatation with the conical steel sound. One of these sounds 
warmed, and of a size corresponding to the bulbous bougie, 
should be passed with the utmost delicacy and gentleness. At 
the strictured and tender points a spasmodic contraction may 
occur, arresting the instrument. 



STRICTURE OF THE URETHRA. 531 

To overcome this patience is better than force. After one 
sound has been withdrawn a second and even a third may be in- 
troduced, if it is considered safe. The tendency is always to 
hurry and use force which is detrimental. It may be stated as a 
rule that if a conical steel instrument of any size larger than 
JVo. 15 will not enter a stricture by its own weight after a little 
delay when held in proper position, it should not be used. If 
force be used in passing sounds the injury will be threefold: 1. 
The production of epididymitis. 2. The excitement of inflam- 
mation in the stricture. 3. The production of chill and urethral 
fever. The patient should wear a suspensory bandage while tak- 
ing this treatment. At each subsequent visit of the patient the 
surgeon commences with a sound from one to two sizes smaller 
than the last instrument introduced at the previous visit and car- 
ries the dilatation as far as possible without the employment of 
force — this till the full size is reached. 

Intervals betrveen the Sittings. — These vary in different 
cases; but it may be stated, as a rule, that it is bad surgery in 
treating stricture by dilatation to re-introduce an instrument — 
unless it be filiform — before the lapse of at least seventy -two 
hours, and that more rapid progress will be made with the case 
by waiting till after ninety -six hours — often even until the sixth, 
seventh or eighth day. The reason for this rule becomes clear 
upon studying the therapeutic effect of pressure upon stricture - 
tissue. The first effect is mechanical (stretching) and sedative 
(quieting muscular spasm at the strictured point); this lasts 
twenty-four hours. The next effect is reactionary (congestive 
and spasmodic), resulting in extra tightness of the stricture and 
increase of discharge; this lasts from 24 to 48 hours. The final 
curative effect is absorptive. Absorption is excited by the in- 
creased activity of the circulation about the stricture, and con- 
tinues for two or three days or longer; after which, contraction 
and growth of stricture-tissue recommences. It is just at the 
period where absorption ceases and recontraction commences that 
a dilating instrument can be reapplied most effectively, and this 
period is, in the majority of cases, on the fifth to the eighth day. 
That absorption takes place during the cure of stricture by 
dilatation may be proved during life by examining the hard car- 



.532 A COMPENDIUM OF PRACTICAL MEDICINE. 

tilaginous bands often found surrounding the urethra, and con- 
stituting stricture. These bands can be distinctly felt, over an 
instrument introduced through the stricture, and, during the 
treatment, observed to become smaller. 

As to the degree of dilatation which is to be aimed at, every 
urethra has its own gauge in the size of its meatus — provided 
that meatus be not congenitally small, or contracted by disease. 
If there is any cicatricial tissue in the circle of the meatus, or if 
a probe can make out any pouching below the lower commissure, 
the meatus is strictured, and requires treatment. The normal 
meatus is the smallest part of the healthy canal, and the object 
in view is to bring all available pressure to bear upon a morbid 
narrowing of some other portion of the tube. To do this the 
meatus must be put lightly upon the stretch. The meatus may 
often be cut, even when not obviously too small, in order to 
facilitate the use of a sound larger than would otherwise pass. 
Strictures of the anterior urethra, if very freely cut, may be radi- 
cally cured; not so strictures of the deep urethra. The latter 
require the use of dilating instruments. 

The size to which a strictured uretha may be dilated, is as- 
certained by measuring the circumference of the flaccid penis; 
circumference of penis, 3 inches; the urethra should take size 30. 
3J inches; size 32. 3^ inches; size 34. 3f inches; size 36. 4 
inches; size 38. 4J to 4^ inches; size 40. (Dr. Otis's 
Standard). 

As soon as a full- sized instrument will slip through a stric- 
ture by its own weight, all symptoms will usually have ceased; 
but recontraction will almost inevitably take place in stricture 
of the deep urethra, unless the sound be passed weekly or fort- 
nightly for a long time (Keyes). 

(/>). Of Small Caliber. — To this class belong strictures ad- 
mitting any instrument less than No. 15. This class of strictures 
requires the same kind of treatment as those of large caliber, 
but arc better treated with soft than with steel instruments. 
There is danger of making a false passage in an obstructed 
urethra with a small metallic instrument. Below No. 15, soft 
instruments only should be employed, unless there be a guide 
through the stricture. Dilatation is carried on as already direct- 



STRICTURE OF THE URETHRA. 533 

eel, steel instruments being used as soon as the stricture will ad- 
mit No. 1?. Progress is slower with soft than with steel instru- 
ments. Cutting (internal urethrotomy) and stretching (divulsion) 
operations are growing daily in favor in the treatment of strict- 
ures of small caliber, yet stricture in the deep urethra is best 
treated by dilatation, no matter how tight it may be. Cutting 
and divulsion are only helps. They are attended by danger. The 
sound must be used after them. The patient need not lose a day 
from business on account of treatment by dilatation. It is safer, 
and more tedious. 

Divulsion or internal urethrotomy may be better in two 
classes of cases: 1. If the patient cannot give time enough to 
carry out dilatation properly. 2. If pretty severe urethral fever 
follows attempts at dilatation. All true strictures of the pen- 
dulous urethra maybe radically cured by free cutting internally. 
Otis proved this. Radical cures are accomplished by free cut- 
ting anteriorly — not so in the deep urethra. In commencing the 
treatment of stricture of small caliber, it may be impossible to 
enter the bladder with any instrument, either on account of the 
tightness of the stricture, or because the point of the instrument 
does not engage in the latter. In these cases gentle perseverance 
and skill will rarely fail of success. Keyes mentions one case of 
his own in which it required ten sittings, most of them over one 
hour long, before any instrument could be made to enter the 
bladder. On the tenth effort, the instrument passed. It entered 
the bladder, and at once the stricture was divulsed. In two 
weeks the patient passed his own full -sized instrument. In the 
so-called impassable stricture, where urine passes out, but no in- 
strument can be made to enter the bladder, a filiform bougie can 
invariably, with patience, be inserted into the orifice of the stric- 
ture (Keyes). 

(c) Stricture of tire Meatus. — Stricture at or near the 
meatus is usually made worse by attempts at dilatation. It must 
be cut. 

(J) Traumatic Strictures. — Are not usually amenable to 
treatment by dilatation. 

(e) Resilient Stricture*. — Will not dilate, must be cut 
(Keyes). Treatment of stricture complicated by — 



534 A COMPENDIUM OF PRACTICAL MEDICINE. 

(a) False Passage. — Results from rough or unskillful use 
of small instruments in an obstructed urethra. On the with- 
drawal of the instrument, blood flows freely from the meatus. 
The treatment for a fresh false passage of this sort is to let it 
alone absolutely for two weeks. To avoid a false passage of any 
kind, when searching for the orifice of a narrow stricture, con- 
sists in filling the urethra with whalebone filiform bougies, thus 
mechanically filling up the false passage, until some instrument 
will glide by its orifice and enter that of the stricture. 

(b) Retention. — A patient, with stricture, may be enjoy- 
ing good health, when suddenly, after exposure to cold, after a 
dinner or a carouse, he finds that he can not pass water. If no 
instrument can be passed, the patient should be placed in a hot 
bath for 15 or 20 minutes, or a sitz-bath. He will often be able 
to pass water while in the bath. A piece of ice in the rectum 
may be tried. A grain of opium may be given every hour until 
four or five doses have been taken. 

(^) Infilftration of Urine. — The infiltrated urine must be 
drained off, and the stricture relieved, The operative indica- 
tions are three : 1. To stop progressive infiltration by extensive 
dependent incisions. 2. To provide an escape for urine con- 
stantly collecting in the bladder, by free central incision of the 
urethra behind the stricture. 3. To divide the stricture 
thoroughly. 

(e) Abscess. — The abscess should be opened. 

(/) Fistulce. — A simple fistula with one or two openings 
will close of itself, as soon as the stricture has been dilated fully. 
In all these cases treat the stricture first, and then the fitsulae. If 
the fistulse remain after full dilatation of the urethra, the patient 
must pass no urine except through a catheter for one month. If 
this fail, the hard edges of the fistulous tract should be incised, 
or cauterized with the gal vano- cautery. A silver probe coated 
with fused nitrate of silver may be passed into the fistulse 
(Keyes). 

Instruments. — The instruments necessary to treat all cases of 
stricture are: different varieties of bougies, sounds and catheters 
with a scale; instruments for divulsion, internal and external 
urethrotomy, and an aspirator. 



STRICTURE OF THE URETHRA. 535 

Bougies. — Filiform bougies are such as measure one milli- 
metre or less in diameter. There are three varieties: the French, 
English, and whalebone. The whalebones are olive-tipped. 
Whalebone filiform bougies have displaced all others at the 
present date. These bougies may be used as guides for larger 
instruments, if made about two feet long. In employing a 
whalebone as a guide it should be first introduced into the blad- 
der then threaded into the instrument to be guided. In intro- 
ducing a filiform bougie when it catches, partially withdraw and 
slightly rotate it, pushing it forward while making the rotatory 
movement. An excellent method of finding the orifice of a strict- 
ure, especially where false passage exists, consists in cramming 
the urethra full of filiform bougies, engaging their points in all 
the lacunae and false passages, and then trying them, one after 
another until one is pushed through the stricture. Injecting the 
urethra full of warm oil is a great aid. Of the other bougies 
(not filiform) the French and English conical are used. The 
French conical are necessary in the treatment of stricture up to 
size 12 or 15. English yellow bougies are smoother and stiffer 
than the preceding. All of the foregoing instruments are intro- 
duced without a stylet by simple direct pressure with rotation. 

The Bulbous Bougie. — Is an instrument necessary for the 
accurate diagnosis of stricture. They consist of a flexible, woven 
shaft, headed by an acorn- shaped extremity. A set of them, 
running from five to thirty, is required. The urethrameter of 
Otis was designed to take the place of a whole set of bulbous 
bougies from size twenty to forty. 

Sounds. — The steel sound is the most necessary instrument 
for the treatment of stricture. Steel sounds are conical or blunt. 
The conical are the better instruments and should run from No. 
13 to 35, inclusive. For dilating stricture soft instruments are 
better in the low sizes — below No. 13, and steel for all sixes 
above No 13. Thompson's rapid dilator and Otis 1 dilating 
urethrotome are much used in the treatment of stricture (Keyes). 



536 A COMPENDIUM OF PRACTICAL MEDICINE. 

SPINAL IRRITATION. 

Is always functional and in most cases is associated with 
congestion or anaemia (Loomis). 

Causes. — It occurs chiefly in women between the ages of fif- 
teen and twenty-five. Spinal shock, or concussion from any 
cause, and all those practices and habits which cause nervous 
strain and result in nervous exhaustion, may also produce spinal 
irritation. Chronic alcoholism and the opium habit may also 
induce it. All severe diseases may cause it (Loomis). Ansemia 
of the posterior columns of the cord is a cause (Hammond). 

Symptoms. — The one constant and special symptom of spinal 
Irritation is tenderness all along the cord or over a single verte- 
bra, which maybe excited by pressure, motion, heat, cold, elec- 
tricity or other irritants. The spinous process is the place where 
pressure causes greatest pain. Tactile hyperesthesia is very 
marked. Motor disturbances are common. Weariness, and 
heaviness occur in the lower limbs. Contraction, twitchings and 
spasm may occur in the muscles of the forearm. Cardiac palpi- 
tation, nausea and vomiting, nervous cough, embarrassed phona- 
tion and breathing, and attacks of fainting are not uncommon. 
Patients are depressed, melancholy, and irritable, and subject to 
insomnia, headache, dizziness, etc. Vaso- motor changes are 
marked; the extremities are cold, sometimes blue, and the face 
alternately pales and flushes. When the point of tenderness is 
in the cervical region the pains are referred to the head, pharynx 
and chest. When it is lower there are respiratory and cardiac 
symptoms, and if in the dorsal region, there is pain in the stom- 
ach with dyspepsia, nausea and vomiting (Loomis). 

Differential Diagnosis. — Spinal irritation may be mistaken for 
spinal congestion, meningitis, myelitis, tumors and tetany. In 
spinal congestion there is no tenderness; and the symptoms are 
aggravated by the supine position; in spinal irritation the 
reverse is the case. 

Spinal meningitis is accompanied by pyrexia, and the pain 
in the spine is increased by motion, and muscular spasms occur 
in the back and neck. The iron band sensation about the waist, 
paralyses, etc., arc almost diagnostic of myelitis. In spinal 



SPINAL IRRITATION. 537 

tumors the symptoms are localized and permanent. In tetany 
there are muscular contractions (Loomis). 

Prognosis. — Is favorable. 

Treatment. — Alcoholic stimulants, meat diet and exposure to 
sunlight and fresh air are of service. Aconite and veratria may 
be applied locally in the form of an ointment. The galvanic 
current and the Faradic current in some cases will give imme- 
diate relief. The daily application of the ice -poultice is recom- 
mended. Absolute rest in the country with a good diet does 
much for these patients (Loomis). 

SNEEZING. 

Treatment. — Camphor is an excellent remedy in incessant 
sneezing with profuse running from the eyes and nose. The 
powder should be sniffed or the alcoholic solution inhaled from 
a handkerchief. One, two or three drops of Fowler's solution 
three times a day are very efficacious in the paroxysmal sneezing 
allied to asthma. In ten -grain doses several times a day iodide 
of potassium is said to cure that troublesome and obstinate af- 
fection, violent paroxysmal sneezing (Ringer). 

SOMNAMBULISM, 

Is a condition incident to sleep. It embraces the mental and 
physical performances, sometimes very extraordinary, which are 
observed in sleep-walkers. Similar phenomena are observed in 
the condition known as the hypnotic or mesmeric or magnetic 
sleep (Flint). 

Treatment. — In these cases bromide of potassium is probably 
the best remedy if given in large doses (Ringer). 

SORE FEET. 

A tablespoonful of common washing soda, added to half a 
gallon of warm water, is useful in the treatment of tenderness of 
the soles. The feet should be immersed for half an hour twice a 
week or oftener (Ringer). 



538 A COMPENDIUM OF PRACTICAL MEDICINE. 

STINGS. 

Insect- stings in the United States are not very severe, and 
unless inflicted in large numbers are rarely brought under the 
notice of physician or surgeon. Slight fever and constitutional 
disturbance may follow them in children who are very suscepti- 
ble to external influences, whilst local swelling, heat, and red- 
ness are very marked in others. Should a wasp or bee acciden- 
tally be taken into the mouth with fruit and the base of the 
tongue, pharynx, or larynx stung, serious symptoms may arise 
from oedema and swelling of the parts impeding respiration. 
When this accident happens, scarifications should be employed 
with fomentations; but if life be threatened, the wind-pipe must 
be opened. 

The sting should be removed, if possible, with forceps. A 
drop of liquor ammonia, or sal volatile, or oil of lavender ap- 
plied to the part generally gives relief. The parts should be 
protected from the air by collodion, flour, chalk or strapping. 

For mosquito -bites Dr. J. Stevenson advises the use of a 
moist cake of soap, the thin lather from the cake being allowed 
to dry upon the bitten part. All pain and itching, he states, 
disappears within ten minutes of this application. In South 
America the mosquito -bite is at times attended with severe local 
inflammation and sometimes with ulceration. 

In Africa and Asia the scorpion, which is from six to ten 
inches long, is so venomous as to cause by its bite, at times, loss 
of life. Olive oil is the usual application for the wound, but 
liquor ammonise is probably better. Brandy and ammonia should 
be given internally when great depression exists. 

The bite of the tarantula is very troublesome and is often 
followed by nervous depression, vomiting and local pain. The 
bite of the spider is very similar in its effects to that of the scor- 
pion, though the wonderful stories as to its poisonous qualities 
are now regarded as fabulous. 

Serpent-bites are often serious, and at times fatal. Stimu- 
lants should be given in large quantities and the part cauterized 
by nitric acid, carbolic acid, or nitrate of silver (Bryant). 



SUDAMINA— SHOCK AND COLLAPSE. 539 

SUDAMINA. 

Is an eruption which consists of little elevations of the cu- 
ticle, about the size of pinheads, filled with a watery fluid (niiliaiy 
vesicles), which consists of the secretion from the sudoriparous 
glands. It is usually clear and transparent. These vesicles 
never run together, are most abundant on the neck and trunk, 
and are met with in those who have been perspiring freely as 
the result generally of some acute affection, such as rheumatic or 
enteric fever or pneumonia, etc. The vesicles dry up in a day 
or to. The vesicles are due to the excessive secretion of sweat 
(Anderson). 

Treatment. — If there be much irritation of the skin, a mild 
astringent lotion may sometimes give relief. We should do our 
best to keep the patient cool (Anderson). 

SHOCK AND COLLAPSE. 

Are terms used to signify the loss of power which imme- 
diately follows severe injuries, esj)ecially those attended with 
violence. It is due to reflex paralysis of the vaso-motor system 
of nerves. The gradations of shock and collapse are innumera- 
ble, and the symptoms by which they are characterized vary from 
a passing faintness or disturbance of the heart's action to final 
syncope. The state of collapse may be regarded as a chronic 
syncope (Bryant). 

Causes. — Slwch may be caused by any severe injury, especi- 
ally gunshot wounds, compound fractures, severe burns, pro- 
tracted surgical operations and all cases in which serious injury 
is attended with violence, pain and loss of blood. Mental shocks 
may be as severe and fatal as those of the body, as for instance: 
A man receiving unexpectedly, some startling news which 
excites severe emotion and dying suddenly is said to die from 
shock; a second receives a fatal blow upon the epigastrium; a 
third is struck dead by lightning; death in each case is said to 
be due to shock. In all the heart's action is suddenly arrested 
through the nerve centre — in one case through the mind, and in 
the others through the body (Bryant). 



540 A COMPENDIUM OF PRACTICAL MEDICINE. 

Symptoms. — A man receives an injury and is not killed, but 
collapsed. He has sustained a shock more or less intense and as 
a consequence becomes cold and almost pulseless. His skin ap- 
pears to be bloodless and covered with a cold clammy sweat. He 
breathes with sighs and gasps. His nostrils dilate, his eyes are 
dull and vision is imperfect. Sometimes shock is so severe that 
the patient sinks from it without reaction. It should be noted 
that vomiting is often the first indication of reaction in general 
collapse as it is often in that of head injuries. Patients with bad 
kidneys are very liable to surfer from shock and to succumb to 
any operation, however trival (Bryant). 

Treatment. — The patient must be kept in a horizontal posi- 
tion; free access to air provided; and cold water dashed into his 
face. In severe cases whisky should be injected under the skin. 
Hot brandy and water, if the patient can swallow it, is probably, 
more efficient than anything else. External warmth should be 
secured by means of blankets, hot flannels, and hot water bottles. 
Bleeding, if any exist, must of course be checked (Bryant). 

SUPPRESSION OF URINE. 

In suppression no fluid comes down the ureters into the 
bladder. 

Causes. — Suppression may be caused by fright or strong 
mental emotions, injury to the kidneys, or the onset of an inflam- 
matory attack, and by the effect of cold, or if the kidney be the 
seat of previous chronic disease, by operations on the bladder or 
urethra, or even by the introduction of a sound or lithotrite, by 
the passage of kidney-stone, etc. (Keyes). 

Symptoms. — Are depression, languor, with apprehension, 
more or less fever, with hot, dry skin, and hard pulse. There 
may be chill, vomiting, headache, and pain in the back and loins 
with constipation. No urine is voided, or only a little high- 
colored secretion. Suppression may come on gradually from ad- 
vancing cl ironic kidney disease. In this case, there is usually 
anasarca. The area and other products of waste accumulate in 
the blood and the patient becomes poisoned by them. Drowsi- 
ness and stupidity, perhaps delirium and coma, come on; there 



SYNOVITIS. 541 

may be convulsions, and the patient dies in from two to five days. 
On the other hand, cases of suppression after scarlet fever, one of 
seventeen and another of thirty days, have been reported. Sup- 
pression for seventeen months, with recovery has been recorded 
(Keyes). 

Diagnosis. — Is easy. In retention the bladder is full, in 
suppression empty (Keyes). 

Treatment. — Dry cups and hot fomentations over the kidneys, 
hot-air bath and hydragogue laxatives, the free use of warm 
drinks, flaxseed-tea, etc.; and if there be no inflammatory condi- 
tion full doses of acetate of potash and infusion of digitalis may 
be tried. 

SYNOVITIS. 

Is an inflammation of the synovial membrane. It may be 
acute or chronic. 

Causes. — This disease may be caused by wrenches, blows, 
punctures, strains, exposure to cold, or sudden changes of tem- 
perature after violent exercise, or may be dependent u/pon con- 
stitutional affections, such as rheumatism, gout, or syphilitic 
or gonorrhceal poisons, etc. Scrofula may cause a synovitis 
(Loomis and Sayre). 

Symptoms. — The knee is the joint most frequently affected. 
There is severe aching pain in the joint, increased by motion, 
great swelling, redness of the surface, tenderness and fever. As 
a rule, synovitis does not affect more than one joint; and as there 
is scarcely any or no effusion into the surrounding tissue, the out- 
line of the joint can be distinctly discerned and fluctuation is 
readily detected. When the knee is affected the patella is 
pushed forward and there is great fullness on each side of it and 
at the lower and front part of the thigh (Sayre and DaCosta). 

Treatment.- — -The limb must be kept absolutely motionless. 
A splint must be applied so as not to touch the affected part. 
Leeches to the joint, cups in the neighborhood and evaporating 
lotions or hot fomentations are useful. Calomel purgatives 
should be administered and opiates to relieve pain. When there 
is a tendency of the disease becoming chronic iodide of potassium 
should be administered. And if the disease be connected with 



542 A COMPENDIUM OF PRACTICAL MEDICINE. 

rheumatism ammonia and potash should be prescribed. Where 
there is a tendency to gout, colchicum with potash is to be em- 
ployed. In syphilitic cases, mercury in its different forms is 
most to be relied upon (Horwitz). 

SYPHILIS. 

Is a general dyscrasial blood-disease caused by the absorp- 
tion of a peculiar virus into the circulation, manifesting itself 
primarily by the appearance of a poisonous sore at the point 
where the virus entered, and afterwards by a succession of 
morbid manifestations occurring at longer or shorter intervals, 
which may affect every organ and tissue of the body. The virus 
is only known by its effects. Exactly what it is has not yet been 
determined. But it is more than probable that it is a living 
contagious element. 

Diday and Rollet failed to inoculate syphilis upon cancerous 
patients, and assume an antagonism between the two maladies; 
but Keyes says, u This surely does not exist, as I have seen many 
of the varieties of cancer upon syphilitic patients.'" 

Hutchinson has happily compared syphilis to the contagious 
exanthemata, small-pox, measles, scarlet fever, as possessing all 
the peculiar characters common to this group of diseases, namely: 
it is communicated only from one diseased person to another 
healthy one; it has a stage of incubation before any sign of the 
disease appears; it has a stage of efflorescence, which indeed in 
syphilis is prolonged and marked by relapses; it has a period of 
decline and sequelae — the later tertiary lesions — which^ do not 
always occur, and during which the disease often ceases to be 
communicable. 

Again, most of the varied efflorescences of syphilis, like 
those of the other exanthemata, tend to pass away spontaneously 
after a time; thus, as Fournier aptly puts it, affording a triumph 
to every method of treatment. One attack confers immunity 
from another often for life, always for a long period. The dis- 
ease; is transmissible by inheritance, as in the case of the other 
exanthemata when the child is born before the mother recovers 
from disease. Finally the sequelae do not constitute transmissi- 



SYPHILIS. 543 

ble disease even by inheritance. As in the other zymotic dis- 
eases, a portion of the virus, however small, is capable of infect- 
ing the whole body as if by fermentation. Thus the analogy of 
syphilis with the contagious exanthemata is clear, only its febrile 
symptoms are less marked, its efflorescences more varied, and its 
course much more protracted — counted by months instead of 
days — and more subject to variation as well as more amenable to 
treatment. Syphilis is fortunately only contagious, it is not in- 
fectious; its poison is not volatile, is not diffused in the air; 
direct contact of the virus with a surface capable of absorption 
is essential to the production of the disease. 

A patient may have malignant scarlet fever and die in a 
day without a sign of eruption, but still he has scarlet fever, as 
no one denies. Even if one syphilitic chancre out of twenty 
w x ere not indurated the other nineteen would be amply sufficient 
to establish a rule. But the proportion is far larger and there is 
perhaps no symptom of any disease more constant than is the in- 
duration of syphilitic chancre, yet the patient does not have syph- 
ilis because his chancre indurates, he already has syphilis 
before his chancre appears. If he did not have it he could 
have no chancre at all and the induration of that chancre is 
just as much one of its symptoms as is ulceration of a chancroid. 
A patient who has absorbed syphilitic virus has syphilis at once, 
and because he has syphilis he gets a sore at the point of en- 
trance of the poison after a period of incubation, as the first 
symptom of the disease. This chancre may be destroyed by 
caustic, or the knife, but the disease will run its course unaltered 
(Keyes). 

Interval Before Absorption. — Clerc tells of a medical student 
who washed himself immediately after sexual intercourse and on 
careful examination for several days subsequently detected abso- 
lutely nothing; twenty- eight days afterward chancre appeared, 
followed by general syphilis. Hill relates the case of a man who 
in sexual intercourse tore his framum which bled freely and fear- 
ing infection called upon Hill within twelve hours after the acci- 
dent to cauterize it with fuming nitric acid. About one month 
afterward the scar indurated. It never ulcerated again but the 



544 A COMPENDIUM OF PRACTICAL MEDICINE. 

regular manifestations of true syphilis came on at the usual in- 
tervals. 

Diday cauterized a syphilitic chancre within six hours after 
its appearance; but although the sore healed promptly, general 
syphilis followed. The rapidity of absorption of the poison of a 
snake -bite is well-known, as is also that of rabies and the poison 
of a dissecting wound, and there is no reason why that of syph- 
ilis should be less so (Keyes). 

Second Attack of True Syphilis. — Hutchinson saw a well 
marked case, in a physician, of two attacks of syphilis, each pre- 
ceded by its characteristic syphilitic chancre. The same patient 
had had small -pox twice. He records a case in which a woman 
with mild inherited syphilis got a new attack in the usual way 
at the age of twenty. Diday has collected twenty-five cases, of 
which he personally saw twenty, of reinfection. In all of these 
cases there was syphilitic chancre with characteristic induration, 
occurring a second time after a previous syphilis. Diday con- 
cludes that the minimum time for the cure of syphilis is twenty - 
two months, and that, where syphilitic chancre appears twice in 
the lifetime of an individual, the second attack should not be 
treated until symptoms of secondary syphilis appear, as these 
may never come on, the whole attack consisting simply in syph- 
ilitic chancre. Keyes says that he can honestly state that he has 
never seen a case of syphilitic reinfection to recognize it. He 
also says, "While, then, a second true syphilitic infection is pos- 
sible even while the subject bears the marks of late tertiary dis- 
ease, yet such infection is eminently exceptional, and allowance 
must be made in the reported cases for (1) chancroid accom- 
panied by some eruption, as a coincidence; (2) ecthyma mis- 
taken for syphilis, after which the first true syphilitic infection 
might pass for a second; (3) false chancre, indurated mucous 
patch; and (4) cases of tertiary ulcer faultily diagnosticated 1 ' 
(Keyes). 

Transmissibility to Animals. — Besides this peculiarity of only 
appearing once in a given individual, syphilis differs from chanc- 
roid in not being transmissible to animals. So faras experimen- 
tal demonstration yet goes, it must be asserted that the sad privi- 
lege of having true syphilis belongs only to man (Keyes). 



SYPHILIS. 545 

Incubation of Syphilis, — After the poison of syphilis has been 
absorbed, the break in the epithelium through which it entered 
heals, and the virus ferments as it were, in the blood, until it is 
ready to give itself local expression, first at the point of entrance 
in the form of syphilitic chancre. This period of incubation or 
hatching, has been critically studied by many authors, both by 
inoculation upon healthy subjects and clincially by close observa- 
tion of patients. The usual period after contact, or inoculation, 
at which a chancre first appears is about the end of the third 
week. In exceptional cases it may be ten weeks. The longest 
period of incubation that Keyes could find among the authentic 
cases of experimental inoculation is forty- six days. There is no 
case on record of an incubation less than nine days, except one 
case reported by Taylor, and one by Hammond. During the 
jDeriod of incubation the patient bears no sign of disease. Dur- 
ing the fourth week after exposure a syphilitic chancre appears, 
and this is, perhaps, the most valuable mark of a syphilitic 
chancre, and practically all sores appearing later than ten days 
after suspicious contact must be regarded with distrust, while 
those coming sooner may be more lightly considered (Keyes). 

Multiple Inoculation. — It has been found, that where many 
points were inoculated at the same time, usually all took and 
appeared simultaneously as chancres. Inoculations made upon 
different individuals, with virus derived from the same lesion, 
have required different periods of incubation for their develop- 
ment. Hunter said, that syphilis was not reinoculable upon an 
already infected person. Fournier believes that about two per 
cent, of auto -inoculations of syphilitic chancre take. The rule 
then is this : Keinoculations of syphilitic virus upon patients 
already syphilitic produce no results. Auto- or hetero- inocula- 
tion upon a patient with very young chancre is occasionally suc- 
cessful. Hetero-inoculation during the late tertiary stao-e of the 
disease is more often successful. At both of these periods the 
patient is not fully protected, the system not being saturated 
with the syphilitic poison at first, and the virus being at a 
minimum toward the end (Keyes). 

Secretions i'<ij><il1< of Transmitting Syphilis by Inocula- 
tion. — Inoculations of healthy subjects with the fluid secreted by 



546 A COMPENDIUM OF PRACTICAL MEDICINE^ 

syphilitic chancre, mucous patches, any secondary cutaneous or 
mucous lesion yielding a discharge, and of syphilitic blood 
drawn from a patient with an eruption, taken either from a 
papule, or tubercle, or from the healthy skin between the lesions 
— all such inoculations yield indurated chancre after a period of 
incubation, which chancre is succeeded by general syphilis. The 
blood of syphilis is poisonous in the intermediary periods be- 
tween the eruptions, when the skin and mucous membranes are 
sound, as vaccinal syphilis proves. 

The secretions of other pathological lesions not syphilitic will 
not produce syphilis unless some of the patient's blood be inocu- 
lated at the same time. Gonorrhoea acquired from a syphilitic 
patient having at the time only gonorrhoea, reproduces itself as 
gonorrhoea and not as syphilis. The same is true of chancroid. 
Diday inoculated pus from a pustule of acne produced upon a 
patient "in full syphilis " by the administration of iodide of 
potassium. The result was negative. The same is true of the 
vaccine virus. Pure vaccine virus taken from a syphilitic pa- 
tient before there is any pus in the vesicle will produce vaccinia 
only, if no blood be inoculated. Since syphilis can been commun- 
cated by vaccination it is wiser always to use lymph from the 
calf and never humanized virus. Inoculation has failed to pro- 
duce positive results from ulcers of the late tertiary period of 
syphilis. Diday inoculated sixteen times with blood from pa- 
tients suffering from tertiary syphilis (nodes), always with neg- 
ative results. The fact that patients with tertiary syphilis may 
occasionally acquire a chancre and the earlier eruptions anew 
and the other undoubted fact that such patients may procreate 
healthy offspring, render it still more certain that late tertiary 
syphilis is no longer either communicable or transmissible. But on 
the other hand, women who have positive tertiary symptoms un- 
doubtedly procrerate diseased children sometimes, just as they as 
certainly often produce healthy ones. Hence tertiary syphilis 
may be said to be generally but not always free from the dan- 
gers of transmission and communicability. The older the disease 
the less apt it is to be transmitted. The male loses the power of 
transmission seemingly long before the female. 



SYPHILIS. 547 

None of the physiological secretions or excretions can pro- 
duce syphilis by inoculation. Mucus from the mouth of a syph- 
ilitic patient having no lesions of the mucous membrane at the 
time has been tested often. Diday has inoculated saliva without 
success. If mucous patches exist, then the saliva produces chan- 
cre when inoculated, as shown by the interesting cases of tattoo- 
ing reported by Maury. Vidal has proved the harmlessness of 
tears, and the sweat and urine have been in a similar way re- 
lieved of blame. The semen has been inoculated by Mireur, 
taken from a man in the full bloom of secondary eruptive disease. 
Milk from a syphilitic woman is neither inoculable experiment- 
ally nor does it give the disease to the child who drinks it. 
Where the nurse has a syphilitic lesion of the nipple, the child 
surely becomes poisoned if it have a fissure or other abrasion of 
the lips through which the poison can be absorbed; but in such 
case syphilis in the child is always preceded by chancre of the 
lips or mouth (Keyes). 

Methods of Transmission of Syphilis. — Syphilis always com- 
mences as a chancre, with two exceptions — or rather one alleged 
exception, the choc-en-retour ; the other a real exception — that 
of inherited disease. 

Choc-en-retour. — Keyes says, "This is a misty condition, 
probably only a high-sounding title to conceal ignorance. " Init 
the ovule of a healthy woman is supposed to be infected with 
syphilis by the semen of the syphilitic father, a semen which the 
direct test of inoculation proves to be void of any poison. The 
syphilitic germ grows, and in its turn poisons the mother, who 
thus becomes diseased without the necessity of having any pri- 
mary lesion. Because no chancre has been ^observed in these 
cases dose not prove that she never had it. Many a woman, pos- 
sibly the greater number having syphilis, gets the disease without 
any knowledge of the primary lesion. 

The Choc-en-retour does not appear very reasonable, because 
it has not been proved absolutely that the syphilitic father, the 
mother remaining sound, can infect the child through the semen 
(Keyes). 

Inherited Syphilis. — When a child is born with inherited 
syphilis, it naturally never has had a chancre — a primary lesion. No 



548 A COMPENDIUM OF PRACTICAL MEDICINE. 

one doubts that a mother in active syphilis aborts, miscarries, or 
produces a diseased child. As to whether the father can pro- 
duce a diseased child by infecting the ovum through impregna- 
tion without infecting the mother (and through her the ovum), 
is a question not yet settled. That a father may have syphilis 
and still have a healthy child is proved by Mireur. He leans to- 
ward the belief that, if the mother escape, a syphilitic father can 
not produce a syphilitic child. He also demonstrates that both 
jDarents may still suffer from tertiary lesions, and produce seem- 
ingly healthy children. When the mother has syphilis, it has 
been shown that she may have a healthy child while under 
treatment, and a diseased one if the treatment be left oif before 
she has passed the virulent stage of the disease. 

Finally, that a man himself syphilitic, with a syphilitic wife 
and a non- syphilitic mistress, may have a diseased child by the 
former and a healthy child by the latter, the two children being 
born within fifteen days of each other, seems to be fully proved 
by Charrier's case. Keyes says, "The great stumbling-blocks to 
me, standing in the way of my seriously accepting the fact that 
a child may be born syphilitic and still have a healthy mother, 
are the failure of direct inoculation upon such mothers, and the 
so-called Colles's law, namely, a child born syphilitic can not 
poison its own mother, but may poison a healthy wet-nurse" 
(Keyes). 

The Methods of Contagion are Immediate and Mediate. — 
Syphilis is very often transmitted by means other than sexual 
contact, more so than chancroid. Surgeons and accoucheurs get 
chancre of the fingers by inoculating abraded spots in the exer- 
cise of their professional duties, and in their turn may spread the 
disease. A midwife, with a syphilitic lesion upon her finger of 
which she was aware, communicated the disease directly and 
indirectly to forty -five persons. She was convicted and sen- 
tenced to twelve months' hard labor. Chancre is frequently 
transmitted in kissing, a little mucous patch in the mouth of one 
party poisoning any fissure on the lips of the other. Both of 
these methods are immediate. 

Children acquire chancre of the lips from nursing-women 
with mucous patches of the nipple, and, on the other hand, 



syphilis. 549 

healthy nurses get chancre of the nipple by suckling children 
with inherited syphilis who have mucous patches of the lips. 
Colles's law that a child with mucous patches of the mouth can 
not produce ulceration of the nipple if it sucks its mother, 
depends simply upon the fact that its mother already has syph- 
ilis before the child is born, and consequently can not get a new 
chancre of the nipple. The following are examples of mediate 
contagion: Puche speaks of a gentleman with a long prepuce, 
who, after marriage, encountered an old mistress, with whom he 
had intercourse. Returning home shortly, without having 
washed, he repeated sexual intercourse with his wife, depositing 
the virus from his prepuce in her vagina. He escaped, but in 
due course, she developed chancre and general syphilis. A simi- 
lar authentic instance is related of a woman who proved unfaith- 
ful. Her husband, embracing her shortly afterward, relieved 
her of the poison left in her vagina by her lover, himself devel- 
oped chancre, while she escaped. 

Smokers of a pipe sometimes get chancre of the lips, the 
virus being deposited upon the mouth -piece of the pipe by some 
previous smoker who had mucous patches of the lip. Toys may 
communicate the disease to a child; tooth-brushes and cigars to 
an adult. Glass-blowers get syphilis in the same manner, as 
they work in sets of three at the same tube, passing it from 
mouth to mouth. Syphilis sometimes runs through a whole 
family, from the use of the same spoons or cups, passed from one 
mouth to another. Washerwomen become infected in cracks of 
the fingers through the virus contained upon soiled clothes. 
Wet-cups, transplanting teeth and passing the Eustachian cathe- 
ter have proved sources of mediate contagion. Circumcision 
and vaccination are familiar instances of mediate contagion. In 
all such cases chancre precedes the development of general 
syphilis (Keyes). 

For the Induration, Ulceration and General Characters of 
a Chancre, see Chancre. 

For Syphilitic Bubo, see Bubo. 



550 A COMPENDIUM OF PRACTICAL MEDICINE 

GENERAL SYPHILIS. 

Primary syphilis includes the chancre and its accompany- 
ing adenitis, and lymphangitis. A chancre never does nor can 
appear elsewhere than at that point through which the poison 
first entered the body. Hence, inherited syphilis has no primary 
stage, but is general from the start. 

Primary Syphilis, so far as its manifestations go, is purely 
local. Not so with general syphilis. There is no organ or tissue 
of the body through which it may not manifest its presence by 
symptoms. The lymphatic glands all over the body may suffer. 
The skin from crown to sole, the nails, the hair, and the mucous 
membranes have their peculiar affections due to syphilis. The 
eye and the testicle do not escape, and each and every viscus is 
liable to be invaded, as are all the tissues, connective fibrous, 
muscular, cartilage, bone, brain, nerve, and vessel. The all-em- 
bracing arms of general syphilis may destroy any function. 
Syphilis may destroy any special sense, produce local or 
general paralysis, acute or chronic mania, dementia, lunacy, 
idiocy, etc. 

General Syphilis has been divided into a secondary and 
tertiary stage. 

Secondary Syphilis includes all the earlier affections of the 
skin and mucous membranes, and many of the lighter affections 
of the eye, testicle, and other glands, with some of the varieties 
of nervous syphilis. 

Tertiary Syphilis follows secondary, and consists of the 
later and the ulcerative skin- affections, the deeper lesions of con- 
nective tissues, muscle, bone, cartilage, and of the internal or- 
gans and all gummy deposit. 

Secondary syphilis lasts often a year, sometimes two or 
more. 

Tertiary syphilis (except as malignant) does not commence 
till after the expiration of at least one year from the appearance 
of the chancre. It may never show itself, or may appear after a 
period of health of many years, often five or ten, sometimes as 
late as fifty- two (Fournier). The whole secondary stage may 
be skipped under treatment, or even without treatment (Keyes). 



SYPHILIS. 551 

Syjpliilides. — The most conspicuous symptoms of general 
syphilis affect the skin, and are known as syphilicles or syphilo- 
dermata. It may be papular, vesicular, or pustular syphilide 
(Keyes). 

Prognosis. — Babies with inherited syphilis suffer more than 
any other class. The malady is often fatal with infants. Next 
in severity come the cases acquired in early manhood. Excesses 
of every sort, of wine, of women, of work, are liable to intensify 
the type and duration. All local irritations tend to call out 
eruptions at the points irritated. A child born with inherited 
syphilis may give no evidence of his malady until he is vaccin- 
ated, when an eruption may apjDear. A blister may call out 
dormant syphilis upon an adult. Patients who work much with 
the hands are more liable than others to eruptions of the palms. 
Tobacco chewed or smoked is proverbial for its power of origin- 
ating and maintaining mucous patches in the mouth. The rough 
edge of a tooth may keep up a mucous patch of the tongue. 
When a bone breaks in a syphilitic subject, even in one with 
latent syphilis, it may fail to unite unless iodide of potassium be 
given. The prognosis is more unfavorable with bad hygiene 
(Keyes). 

Duration of General Syphilis. — There is no disease so protean 
in its form as syphilis. Its symptoms simulate those of a vast 
number of other diseases. So true is this that it has passed into 
a proverb in the face of an obscure disease, "If you do not know 
what to do, treat the patient for syphilis." It is difficult to say 
when syphilis has ended or of deciding that it ever does end. 
Syphilis may occur in so mild a form that the patient may never 
know he has it. Syphilis may manifest itself as a mild eruption 
after chancre, disappearing possibly without treatment, and then 
lie latent for many years, as long as fifty-two years, to reappear. 
Keyes has a case where syphilis was latent for about forty years. 
Syphilis once acquired, stamps its impress upon the individuality 
of the patient and becomes a part of him and no power on earth 
in a given case can say when that impress disappears. A half 
century may pass away and the trail of the serpent be still visi- 
ble. Yet syphilis may be cured. The virulence of syphilis dis- 
appears in the late tertiary period and during this period neither 



552 A COMPENDIUM OF PRACTICAL MEDICINE. 

the blood nor the pathological secretions will infect a healthy 
subject with the disease. Of the two diseases gonorrhoea and 
syphilis, the former sends more patients to the tomb than the 
latter. Keyes says that a man may get chancre, followed by 
some light eruption, consider it of no importance and get well 
spontaneously, marry and have healthy children, himself remain- 
ing entirely free from any evidence of the disease and dying in a 
green old age (Keyes). 

Syphilis and Marriage. — If a patient presents himself with 
syphilitic chancre, at what period may he safely marry ? He 
should not marry earlier than four years after chancre, and it is 
better not to marry for five years (Keyes). 

Causes of the Protracted Duration of Syphilis. — 1. Those 
living in bad hygienic surroundings, and giving themselves up 
to excesses of every sort. 2. Patients peculiarly susceptible to 
the disease. 3. Patients j)ossessed of a strong tendency to gout 
or scrofula. 4. Those who treat irregularly. 

General Characteristics of Syphilides. — 1. Polymorphism 
of the earlier eruptions. 2. Rounded form of the patches of 
eruption, and of the ulcers. 3. Livid color, like the meat of raw 
ham, then coppery (pigmented), then gray, then white. 4. Ab- 
sence of pain and itching. 5. The earlier eruptions are distri- 
buted habitually all over the body, are superficial, mainly con- 
gestive, and usually symmetrical. 6. Later eruptions in groups, 
involving the cutis vera. 7. Scales white, usually^not adherent, 
superficial. 8. Crusts or scabs greenish, black, irregular, thick, 
adherent. 9. Ulcers with abrupt edges, adherent, not under- 
mined, sluggish, and bleeding easily. 10. Cicatrix rounded, de- 
pressed, thin, non-adherent, white, smooth at first, shining, often 
pigmented, then clearing off from the centre toward the circum- 
ference (Keyes). 

Secondary Incubation. — Primary incubation extends from the 
moment of suspicious contact to the appearance of the chancre. 
This period is about three weeks. Then primary syphilis is 
ushered in; but now there is another period of rest, ^wherein the 
disease seems to be purely local. This period dates from the 
appearance of the chancre to the appearance of general symp- 
toms, and is called wcoikUi ry incubation. This period is on an 



SYPHILIS. 553 

average six weeks, but may be shorter or longer. In rare cases 
the entire secondary period may be skipped, the disease first 
appearing in its tertiary form. This is termed delayed syphilis 
(Keyes). 

Syphilitic Fever. — About a week or more before the appear- 
ance of any eruption, the patient is liable to have fever. The 
poison of syphilis reduces the number of red blood corpuscles, 
and produces more or less cachexia. This syphilitic hydremia is 
constant, but may be slight. Fever is present in about two- 
thirds of all cases, and may be continuous, or it may occur 
only toward night, followed by sweating. With the fever there 
may be a sallow complexion, sunken eyes, melancholy, fatigue, 
shortness of breath, palpitation, and pain in various parts of the 
body. Among the pains of early syphilis, headache is promi- 
nent, and is usually worse at night. 

The treatment is mainly tonic doses of mercury and hygienic 
(Keyes). 

Alopecia. — Falling of the hair due to syphilis is of two 
kinds. Scabby sores on the scalp cause the hair-follicles to be 
destroyed, in which case the fallen hair is not reproduced. Or- 
dinarily there is a thinning of the hair generally, not only of the 
scalp, but of the eyebrows, eyelids, whiskers, and to a degree of 
the whole body. In acquired syphilis the thinning of the hair is 
due to one of two causes (that is, when there are no scabs): 
1. The syphilitic hydremia which, like fever, impairs the vitality 
of the hair- papillae. 2. Seborrhoea, the sebaceous matter clog- 
ging the hair -follicle. 

Treatment. — Shampooing once a week with ammonia or 
borax in warm water (5j. to the Oj.) is useful, and rubbing the 
scalp nightly with a stimulating lotion, as follows : 

Jfc Tinct. capsici 3ij--v- 

Gly cerini 3j . 

Aqua? cologniensis ad gj. — M. — Keyes. 

Indolent Glandular Engorgement. — Is a diagnostic mark of 
the first importance in all doubtful cases of syphilis. The en- 
gorgement of the glands is indolent, painless. They are hard 
and vary in size from a small pea to a marble. The coincident 
indolent engorgement of certain glands is almost pathognomonic 



554 A COMPENDIUM OF PRACTICAL MEDICINE. 

of syphilis. These are the post- cervical, and epitrochlear glands 
on either side, just above and without the inner condyle of the 
humerus (Keyes). 

Sore Throat. — Is a concomitant symptom of all stages of 
general syphilis. There are three type varieties: 1. A diffuse 
general redness, with or without ulceration in the early second- 
ary stage. 2. A certain amount of chronic congestion, and 
brawny thickening about mucous patches or atonic ulcers in the 
late secondary and early tertiary. 3. Destructive ulceration 
from gummy deposit in the tertiary stage (Keyes). 

General Treatment of Syphilis. — Is hygienic, tonic and specific 

Hygienic Treatment. — Includes all the ordinary laws of 
health. Regularity in eating and sleeping is all -important. 
Excesses of any kind are bad. Warm baths should be taken 
frequently. Catching cold and the use of tobacco are apt to 
induce and prolong mucous patches in mouth and throat. 
Change of air may be necessary to effect a cure. Mercury and 
the iodides will not cure all syphilis, as many practitioners seem 
to believe. 

Tonic Treatment. — Cod -liver oil, iron, quinine and other 
tonics must be given, along with the specific remedies. 

Specific Treatment. — Most of the syphilides, especially the 
earlier varieties, are self -limiting, and will get well under any 
treatment — one might even say in spite of treatment. No treat- 
ment may be better than over -treatment. Sarsaparilla has no 
curative power, but assists digestion and promotes the action of 
the skin, and pleases the patient. 

The following formula is serviceable : 

j& Hydrarg. chlorid. corros g r -j- 

Aluminis , gss. 

Ext. sarsaparilla ^ij . 

Gly cerini . §j . 

Syr. sennse giss. 

Spts. anisi 3] . 

Ext. glycyrrhizse .5J . 

Aquae forniculi — q. s., ad -.?viij. — M. 

Sig. : A tablespoonful several times daily. — Keyes. 

Keyes says that the succus alter ans has very little, if any, 

value in the treatment of syphilis, and that the quackish and 



SYPHILIS. 555 

pretentious manner in which it is being forced upon the profes- 
sion is enough to conclem it, and to make any honest man doubt 
its claims. 

The Hot Springs of Arkansas. — Keyes says the springs have 
a positive value in the treatment of syphilis. Patients broken 
down, cachectic, with faulty stomachs, who have syphilitic lesions 
wmich fail to yield at home because they can not tolerate a suffi- 
ciently high degree of medication — these are the patients to send 
to the hot springs. This is the only class of patients Keyes ever 
sends to the springs. The j^hysicians who do well at the springs 
use most unsparingly mercury by inunction and iodide of potas- 
sium internally in enormous doses. The hot water internally 
and the baths enable a patient to tolerate large doses. For ordi- 
nary syphilis Keyes does not consider the springs of any value. 
They do not shorten the duration of the disease, prevent relapse, 
or cure it in any sense. The rule should be: Send no patients to 
the springs who do well under ordinary medication at home. 

Treatment of Early Syphilis. — Should be commenced as soon 
as the diagnosis of syphilis is positive. The rule in all cases of 
doubt is: Do nothing, but frankly tell the patient that he must 
wait; or if he has not the grace to appreciate pure honesty, and 
must have something to do while waiting, give a placebo while 
studying the nature of the sore and awaiting developments. All 
through syphilis mercury has power, an eliminating and con- 
trolling power, if not a curative one. The symptoms of syphilis 
are controlled by mercury better than by any other known drug, 
unless it be the iodidic preparations. Keyes has shown that 
moderate doses of mercury continued for any length of time not 
only do not debilitate, but act as a tonic in health, in disease, in 
syphilis, augmenting the number of red cells in the blood. In 
the early manifestations of syphilis mercury is specially potent. 
Under its kindly influence the chancre heals, the early eruptions 
fade. Mercury properly administered may be taken for years 
without any injury to the individual, or to his constitution, either 
immediate or remote (Keyes). 

Bad Effects of Mercury. — Occasionally a patient appears 
who tolerates mercury badly. He may be unable to take a cer- 
tain form — the protoiodide, perhaps, because it causes pain and 



556 A COMPENDIUM OF PRACTICAL MEDICINE. 

diarrhoea — but can take another. Most people tolerate the bi- 
chloride kindly but a few patients cannot take any form of mer- 
cury without great mental and moral depression. Early spyhilis 
also produces great depression mentally and morally. When a 
patient positively can not take mercury at all then we have to 
fall back upon the iodides, gold, the vegetable remedies, tonics, 
mineral waters and the like. The other bad effects produced by 
mercury are salivation and diarrhoea with griping -pain. Mer- 
curial tremor and cachexia occasionally occur after unjustifiable 
doses of the drug (see Salivation). 

Diarrhoea with griping pains is apt to come on in many 
patients who are fairly under the influence of mercury. If kept 
up, the patient loses appetite, runs down, and fails to derive 
benefit from his mercury. In these cases it is better to lower the 
dose or change the preparation (Keyes). 

Elimination of Mercury from the Body. — Mercury gets out 
of the body chiefly through the intestinal canal, then through 
the salivary glands, the kidneys and the skin. Mercury may 
remain in the system for iive and a half months after the patient 
has ceased taking it by inunction. 

Methods of Administering Mercury. — Are in the order of 
their respective value to the practitioner : 1. By the stomach. 
2. Local. 8. Inunction. 4. Fumigation. 5. Hypodermic. 

5. Hypodermic Injections. — From one-sixteenth to one- 
eighth of a grain of sublimate dissolved in fifteen minims of 
water, is injected once or twice daily under the skin. Abscess 
may follow the puncture, or a hard, painful lump, very lasting 
sometime. This method can never become popular. 

4. Fumigation. — This method is an excellent one, but not 
practical. It requires time and care. It is useful where prompt 
and kindly action of mercury is aimed at. Fumigations may be 
taken daily for three or four days, then once a week is usually 
enough to keep up the mercurial effect. The best method of 
fumigation is that found in Turkish bathing establishments. 
Calomel is the best for fumigation, because it volatilizes readily. 
About a scruple is enough for a bath. The powder should be 
placed upon a piece of tin over the spirit-lamp. The lamp and 
tin are placed beneath a cane-bottom chair, upon which the 



SYPHILIS. 557 

patient sits naked and surrounded by blankets for fifteen minutes 
to naif Hour. 

3. Inunction: — This is perhaps, of all the best means of exhibi- 
ting mercury. It spares the stomach, and is thorough and efficient. 
Its application is very dirty and it sometimes produces a local 
eruption. Keyes thinks that the method of inunction practiced 
at the hot springs is decidedly the best. The patient takes a long 
bath in hot water, and after drying himself, an attendant rubs in 
one-eighth or one-sixth of an ounce of mercurial ointment. The 
friction continues for twenty minutes. The next day this is re- 
peated and the effects watched. Keyes does not use the oleates 
any more. 

2. Load Use of Mercury. — Ulcerative cutaneous lesions do 
better under iodoform. Mucous patches upon the skin do well 
if kept dry and painted with bichloride solution or touched with 
the acid nitrate of mercury diluted, three to five times and dusted 
with calomel. Cleanliness is the first requisite in the treatment 
of lesions upon mucous membranes. The teeth should be cleaned, 
tobacco should be stopped and soothing mouth -washes of borax, 
alum, etc., may be used. The mucous patch may be touched 
with nitrate of silver, sulphate of copper or bichloride solution 
(gr. ij. to 5j) but according to Keyes the acid nitrate of mercury 
pure and applied sparingly with the blunt end of a glass rod is 
the best. The pain it produces on some persons is a drawback 
to its use. 

1. Mercury by the Stomach. — For treating general syphilis, 
the method by the stomach is the best. In this way it can be 
taken while traveling and without making the patient conspi- 
cuous to his friends, and it can be so used as to act as a tonic as 
well as specific. The forms used by the stomach are: the pro- 
toiodide, bichloride, blue -pill, and gray powder. Keyes rarely 
uses the biniodide, as it is too irritating to the intestine. Gray 
powder and blue-pill are good preparations when the protoiodide 
proves too irritating to the intestine. The bichloride is a very 
tonic preparation, and is more prompt than the others. 

Tonic Method of Treatment by Mercury. — Consists in the 
use of mercury in such a way that the mercury, over and above 
its antisyphilitic effect, shall act as a tonic — that is, shall increase 



558 A COMPENDIUM OF PRACTICAL MEDICINE. 

the number of the red blood- cells, and the general health and 
vigor of the patient. The outline of treatment is as follows: 
The standard fractional dose being selected — one-sixth grain of 
protiodide, and one -thirtieth grain bichloride — it remains to find 
the "full dose" and the "tonic dose."" The course is commenced 
by causing the patient to take one granule or tablet of the stand- 
ard fractional dose immediately after each meal for three days 
— that is, three a day. For the next three days he takes four 
granules a day; then for three days, five a day; then for three 
days, six a day; then seven, and so on, adding one granule to the 
daily dose each fourth day, until pernicious medicinal effects of 
mercury begin to show themselves, which are, with the protoio- 
dide, usually griping pains in the abdomen, and at least two free 
watery stools a day. When this occurs, write down the daily 
number of pills required to produce it, and name this number 
the "full dose." 

Half the full dose is the "tonic dose," and sometimes one- 
third is all that is required. The "tonic dose" may be com- 
menced with the idea of continuing it daily, month after month, 
for an average of about two and a half years. Under this tonic 
dose, Keyes says the patient will often enjoy better health than 
he did before he got his chancre. If new symptoms appear then 
is the time to add the reserve dose or to throw in some iodide of 
potassium for a time. This tonic course of treatment is elimina- 
tive not suppressive. By this course patients can be assured that 
they are taking mercury in the mildest manner, that it will not 
hurt them if they continue taking it for several years, and that 
it will not remain in the system (Keyes). 

Treatment of Late Syphilis. — In purely gummatous deposits 
the iodides only are required. 

Mixed Treatment. — When during the tonic course there is a 
call on the part of the symptoms for the iodides, they may be 
given while the mercury is continued. 

The Iodides. — Often the iodides have to be used alone and 
pushed to the point of tolerance. The iodides are agents of the 
very highest value in syphilis, and in purely gummatous and 
many of the nervous symptoms their action in very large doses 
is most gratifying. The iodide of potassium is the most efficient 



SYPHILIS. 559 

of the group. The disagreeable after -taste left in the mouth by 
iodide of potassium may be best masked by peppermint. The 
best time to take the iodides is during the third hour after eating, 
when the contents of the stomach are neutral and yet the organ 
is not empty. Even on an empty stomach the drug goes well if 
very largely diluted in milk. 

The Dose of the Iodides. — There is no limit. Keyes has 
given two and a half ounces daily. Begin with the small dose 
and work up gradually to the maximum dose. 

The Bad Effects of the Iodides. — The metallic taste in the 
mouth is always much complained of when the dose runs high. 
The bad effects are Hve : 1. Possible indirect causation of sali- 
vation. 2. Iodism. 3. Irritation of mucous membranes. 4. 
Cutaneous eruptions. 5. Anaemia with nervous prostration and 
debility. 6. Albuminuria. Moderate doses of arsenic certainly 
moderate the bad effects of the iodides. 

Duration of Treatment. — The duration of the virulence of 
the disease is believed to subside in the third year, and therefore 
the rational period during which to maintain continued treatment 
is about the same. It is impossible to say to a given patient after 
he has followed this course that he will never have a relapse; but 
he can be told that he has all the guarantee that medicine can 
afford him, and that if he does have late symptoms the great 
probability is that they will be mild, and will promptly yield to 
a mixed treatment (Keyes). 

Syphilis of the Skin and Mucous Membranes, — Thesyphilides 
are those manifestations of general syphilis found upon the 
cutaneous envelope. Those occurring in secondary syphilis are: 
1. Roseola. 2. Papular syphilide. 3. General pustular syphi- 
lids 4. Pigmentary syphilide. 5. Bullous syphilide. 6. Vesi- 
cular syphilide. 7. Squamous syphilide. 8. Turbercular 
syphilide. 

With these occur on the mucous membranes: 1. Erythema- 
tous patches. 2. Ulcers. 3. Mucous patches. 4. Scaly patches. 

The tertiary lesions of the & kin are: 1. Ecthyma. 2. Rupia. 
3. Pustular syphilide in groups. 4. Tertiary ulceration. 5. 
Gummy subcutaneous tumor. 



560 A COMPENDIUM OF PRACTICAL MEDICINE. 

With these occur on the mucous membrane: 1. Mucous 
patches. 2. Scaly patches. 3. Deep chronic ulcers. 4. De- 
structive gummy ulcers (Keyes). 

TAPE=W0RMS. 

Constitute the class cestoda. 

Varieties. — Taenia saginata, beef tape -worm, is the form most 
common in this country; tsenia solium is occasionally encountered 
while the bothriocephalic latus is rare (Bartholow). There was 
a time when nearly every malady was attributed to worms. 
Taenia solium also called "armed tape-worm " is the final devel- 
opment of an embryo, usually lodged in the flesh of some animal. 
It is from seven to thirty feet long, has a globular head and flat 
segments or joints. Each mature joint contains both male and 
female sexual organs (hermaphrodite). An ordinary sized tape- 
worm contains five millions of ripe ova. 

The larval form of this worm is the cysticercus celluloses, 
the embryo being found in pork (measly pork). From one to 
forty may be present in the same intestinal tract, in small intes- 
tine and may hang far down into the large intestine; the ter- 
minal ripe segments are constantly falling off, and are discharged 
with the fa3ces. In a few months after swallowing the embryo, 
the tape-worm reaches considerable size. 

Taenia Saginata, also called "unarmed tape -worm," is 
larger, stronger, and thicker than taenia solium. The larval 
form of this worm is the cysticercus saginata, the embryo being 
found in beef. 

The Botltriocephalus latus is the largest worm infecting 
man. This worm sometimes reaches sixty feet in length. Its 
color, unlike the others, is a dull bluish -gray. Some suppose its 
embryo to be found in a fish or mollusk (Loomis). 

Causes. — Since the introduction of the Russian method of 
curing diarrhoea by the use of finely- scraped raw meat, and the 
modem taste of eating rare steaks, etc., tape- worm has become 
more common. Their entrance into the intestinal tract is only 
effected through food and drink. Butchers, and those who 
handle raw meat, are more subject to them than others. Filthy 



TAPE WORMS. 561 

surroundings, squalor and personal uncleanliness are conditions 
which favor their development. Tape- worms occur at all ages. 
Bothriocephalus latus is found chiefly in Scandinavia, Russia 
and Poland. Taenia solium occurs wherever the pig is domesti- 
cated. Taenia saginata is found wherever raw beef is used for 
food. The Tcenia are not found among Jews and those who eat 
no pork (Bartholow, Loomis and Flint). 

Symptoms. — Taenia produces no constant symptoms. The 
bowels are usually irregular. There may be colicky pains in the 
abdomen; the appetite is capricious, the face may be pale, the 
stomach feels weak and there is nausea and perhaps vomiting. 
The principal symptoms are: emaciation, notwithstanding an in- 
ordinate appetite; a feeling of lassitude; palpitation of the heart; 
salivation; faintness and itching about the nose and anus. The 
reflex symptoms are headache, dizziness, ringing in the ears, sud- 
den sweatings and grinding of the teeth. Frequently a tape- 
worm produces absolutely no symptoms. The diagnosis can 
only be made by the discovery of detached joints or segments of 
the worms in the faeces. The length of time they remain in the 
intestine is by no means a fixed period; they have been known to 
exist there ten to twelve years and even longer. Persons fre- 
quently fancy they have a tape -worm. This is one of the notions 
of a hypochondriac and often becomes an insane delusion (Bar- 
tholow, Flint and Loomis). 

Treatment. — Prophylaxis demands that all raw or "under- 
done" meat shall be avoided. Measly pork should be avoided. 
Stockyards should be at a distance from the water supply. 
Green vegetables, such as lettuce, should be thoroughly washed 
before eaten. Sulphate of magnesia should be given each morn- 
ing for two mornings before giving the remedy, the taeniafuge. 
The diet should consist of milk, steak, tea and toast, for the day 
before and during the treatment. German practitioners cause 
the patient to take articles disagreeable to the parasite — such as 
garlic, onions, and salt herring — and direct a plateful of herring- 
salad, a savory dish made up of those articles, agreeable enough 
to Germans, but highly distasteful to tape- worms. 

The most successful treatment of tape -worm Bartholow has 
any knowledge of is that of an ignorant barber, avIlo has a secret 



562 A COMPENDIUM OF PRACTICAL MEDICINE. 

method which seems never to fail. He does not attempt any 
preparatory treatment, but administers his medicine (apparently 
a decoction of pomegranate) in the morning, the patient fasting, 
and retires from the honse with the worm and his fee in the 
afternoon. For the destruction of tape -worms, many remedies 
have been proposed, such as turpentine, male fern (filix mas), 
kousso, pumpkin- seeds, and pomegranate or its active principle 
pelletierine. Oil of turpentine, in one-half or one-ounce doses, is 
one of the oldest and is very effective. Male fern (filix mas) is 
one of the oldest and best known vermifuges. The ethereal 
extract maybe given in half- drachm doses, and the oil in drachm 
doses. Another effective tseniafuge is the kousso, the dried 
flowers of a tree in Abyssinia, where tape- worm is exceedingly 
common. Half an ounce of the powdered flowers mixed with 
water may be given in a dose. An emulsion of pumpkin- seed 
frequently acts efficiently. Pelleterine has been used with in- 
creasing success since its discovery in the proper doses (Bartho- 
low, Flint and Loomis). 

TETANUS, 

Or lock-jaw is a disease characterized by paroxysmal tonic 
contractions of the voluntary muscles and due to exhaltation of 
the reflex function of the spinal cord (Bartholow). 

Causes. — -Tetanus is usually traumatic and may follow the 
most trivial injury, as a splinter in the finger, the prick of a needle, 
the extraction of a tooth or perforating the ears for ear-rings, 
but it is more apt to develop after compound or complex frac- 
tures, lacerated, crushed and punctured wounds and wounds 
complicated by the presence of foreign bodies. It may occur 
after abortion or normal delivery and trismus nascentium is as- 
cribed to the wound at the navel. When a wound is cicatrizing 
tetanus is more apt to occur. It is much more common in hot 
than in temperate climates. Exposure to wet and cold may de- 
velop it (Bartholow and Loomis). 

Symptoms, — Tetanus generally comes on in from six to twelve 
days after the injury, but may be delayed three or four weeks 
or appear within a few hours. In the majority of cases it begins 



TETANUS. 563 

with stiffness of the muscles of the neck and jaw. The affection 
is sometimes limited to these muscles and is then distinguished 
as trismus. The jaws are firmly shut by rigid contraction of 
the muscles and hence the affection is known as lock-jaw. 

When caused by cold, there is chilliness, followed by fever, 
and stiffness of the neck is felt. The attempt to swallow excites 
cramp of the pharynx, and is difficult and painful. By degrees 
the other muscles are involved. The limbs are extended, the 
back arched (opisthotonos), less frequently the body may be 
bent forward (emprosthotonos), and still more rarely laterally 
(pleurosthotonos). The face assumes the risus sardonic as. 
Respiration becomes difficult. Spasms are excited by jars, by a 
mere touch, a current of air, etc. The pain is intense during the 
paroxysm. Between the paroxysms there are heavy ache and 
soreness. Just before death the temperature may reach 112° or 
114° F. The body is bathed in a profuse sweat. Reflex excita- 
bility of the cord is increased to a high degree (Bartholow, Flint 
and Loomis). 

Differential Diagnosis. — The absence of headache, delirium, 
and coma, and a normal temperature in the intervals between 
the attacks, will suffice to distinguish tetanus from any cerebral 
or cerebro- spinal inflammation. Absence of coma distinguishes 
it from epilepsy. In strychnine poisoning the muscles of the 
jaw, head and neck are last and least affected (Loomis). 

Prognosis. — Tetanus usually terminates fatally before the 
tenth day (Loomis). 

Treatment. — Bartholow thinks that bromide of potassium in 
doses of one to two drachms every four hours until the spasms 
cease, has been the most successful agent thus far employed. 
Opium given in large doses is sometimes successful. Recently, 
curare, nitrite of amyl, and hydrate of chloral (in forty-grain 
doses) seem to be the favorite drugs. Loomis is of the opinion 
that a highly nutritious diet, with alcoholic stimulation, is the 
best treatment. Ice applied to the spine has been found useful. 
Inhalations of ether and chloroform have given some relief. 
Light, currents of air, and noise should be excluded from the 
patient (Bartholow, Flint and Loomis). 



564 A COMPENDIUM OF PRACTICAL MEDICINE. 

THRUSH. 

Called also sprue or muguet, is an aphthous disease of the 
epithelium of the mouth and tongue, due to the growth of the 
germs of the thrush -fungus, the oidium albicans. The mucous 
membrane has numerous small round whitish spots which gives 
to it a curdy appearance (Loomis). 

Causes. — In children this disease occurs from birth to the 
second year, and is very rare after that time until adult life. 
These parasitic plants grow best in the presence of acids, and 
hence, the secretion of the mouth for the first six or seven months 
23redisposes to it. Improper feeding, indigestion, gastro- enteritis 
and want of cleanliness in the care of nursing- bottles, spoons, 
etc., are the principal causes. In adults thrush occurs toward 
the end of any long exhausting disease, such as cancer or con- 
sumption (Loomis and Smith). 

Symptoms. — The mouth becomes hot and painful. The 
child will not allow its mouth to be touched. There is saliva- 
tion which is acid. The lips swell and become everted. Diar- 
rhoea is frequent. The stools are acid. The acid causes an 
erythema about the anus (Loomis and Smith). 

Treatment. — To avoid sprue, the mouth of the child should 
be washed with cool water each time after nursing. Borax is 
the most effectual remedy for thrush. After each feeding the 
mouth should be thoroughly cleansed with borax and glycerine, 
or a weak solution of carbolic acid, and sulphate of soda. The 
diet should be restricted to milk and lime-water. When there is 
emaciation, cod-liver oil and the lactophosphate of lime will be 
of service. The bowels must be regulated (Loomis and Smith). 

TINEA. 

Is the generic term for skin diseases produced by fungi. 
There are four diseases of the skin dependent upon the presence 
of four separate fungous growths, viz: 1. Tinea favosa. II. 
Tinea tricophytina. III. Tinea versicolor. IV. Tinea imbricata. 
There are three varieties of tinea favosa, or honey- comb ring- 
(a) Favus of hairy parts, (b) Favus of non-hairy 



TINEA. 565 

parts, (c) Favus of nails. This disease which is decidedly 
contagious, usually makes its appearance in children, especially 
in those who are scrofulous, debilitated or uncleanly. The favus 
of hairy parts is usually seen only upon the scalp. There is 
more or less itching. The odor is characteristic and "mousey." 
The hairs are dull, dry, discolored and easily extracted. The 
fungus may be detected under microscope. The favus of non- 
hairy parts is in the shape of roundish spots which are bright 
red in tint, and at first very small but soon reach the size of a 
crown piece. It is elevated, itchy and scaly. It has yellow 
streaks. The favus of the nails is caused by scratching the af- 
fected part. The fungus gets under the nail and it assumes a 
yellowish tint (Anderson). 

Treatment. — Favus was once thought to be incurable. De- 
struction of the parasite is the only treatment. A solution of bi- 
chloride of mercury is a good remedy. 

There are four varieties of tinea Pricophytina, or ringworm, 
viz: 1. Ringworm of the head. 2. Ringworm of the body. 3. 
Ringworm of the beard. 4. Ringworm of the nails. 

Ringworm of the head is met with almost exclusivelv in 
children. It occurs in patches more or less circular and never 
implicates the whole head. The hairs are discolored, brittle, 
much thickened and twisted or broken off close to the scalp. 
Itching is moderate. It is very contagious. 

Icing worm of the body commences as little round, rose- 
colored, slightly elevated spots, which soon become scaly and 
itchy. The circles of eruption are often several inches in diam- 
eter. It is contagious. Ringworm of the beard, called also tinea 
sycosis, is exclusively met with in adult males. It is almost 
always traced to a "foul shave" in a barber's shop. It is highly 
contagious. The color of the eruption is dusky red (Anderson). 

Treatment. — The parts should be scrubbed night and morn- 
ing with black soap. Such parasiticides as bichloride of 
mercury, carbolic acid, iodine, etc., may be used in the proper 
strength (Anderson). 

Tinea Versicolor is an inflammatory affection, generally 
more or less itchy and scaly. There are small pin-head spot- of 
eruption. On scraping the surface, scales come away loaded 



566 A COMPENDIUM OF PRACTICAL MEDICINE. 

with the parasite. It is a disease of adult life, and never con- 
genital. The color of the patches of eruption is yellow or brown. 
The scales are scanty and very fine. Tinea versicolor always 
commences on the trunk. It is contagious (Anderson). 

Treatment. — Is very simple and efficacious. Generally the 
ap23iication of a solution of bichloride of mercury (two grains to 
the ounce of water), or hyposulphite of soda (5i. to the Si. of 
water), to the affected parts twice daily, and continued for some 
time after the eruption has disappeared, is effectual. Mercurial 
or sulphur vapor baths have the same effect. A thorough 
scrubbing of the patient with black soap night and morning in 
a bath is efficacious. Instead of the black soap, the following 
mixture may be employed : 

JJr Hydrargyri perchloridi gr. xx. 

Saponis viridis |iij. 

Spiritus rectificati ^ij. 

Olei lavandulse gtts. xx. — M. 

Sig. : To be used night and morning, exactly in the same way as 
the black soap. — Anderson. 

Tinea Imhricata. — Called also Tokelan Ringworm, is a 
scaly disease — much more like ichthyosis in its general appear- 
ances than any other disease. The scales run in concentric 
circles, and do not extend deeper than the mucous layer of the 
epidermis. The fungi are present in very great abundance 
(Anderson). 

Treatment. — Same as ringworm of the body. 

TINNITUS AURIUM. 

Is not a disease but a symptom of disease. It consists of 
imaginary sounds and ringing noises in the ear. It is a frequent 
accompaniment of cerebral disorders. It is a sign of little mo- 
ment, for it is encountered in so many different conditions, such 
as, disease of the cerebral vessels, congestion of the brain, Meniere's 
disease, affections of the heart, anaemia, etc. Its cause is some- 
times wax in the meatus. Various drugs will produce tinnitus 
annum in some persons (Da Costa). 



TONSILITIS. 567 

Treatment. — Discover and treat the cause of the tinnitus 
aurium. The following formulae may be tried: 

j& Acidi hydrobromici dil (10 per cent) ^ij. 
Sig.: One-half to a teaspoonful in sweetened water thrice daily. 

— Fothergill. 

J£ Tinct. cimicifugse . XHcix. 

Aqua3. gij . — M. 

Sig. : A teaspoonful thrice daily. — Patton. 

TONSILITIS. 

Is an inflammation of the tonsil. The most important varie- 
ties of tonsilitis are: 1. Acute simple tonsilitis, or catarrhal. 2. 
Follicular tonsilitis, or ulcerative. 3. Parenchymatous or sup- 
purative tonsilitis. 

Acute simple tonsilitis is characterized by redness with 
moderate swelling of the tonsils and an inflammatory exudation 
from the mucous membrane, composed of mucous, pus-cells, and 
serum. This simple tonsilitis is present in most cases of acute 
pharyngitis, or ordinary sore throat, and is a trivil affection. 

Acute follicular tonsilitis, or ulcerated sore throat, is of con- 
siderable clinical importance. In this affection the inflammation 
involves not only the mucous membrane covering the surface of 
the gland, but especially that lining the crypts. The tonsils 
present little white patches. These white deposits extend into 
the crypts or follicles. Acute follicular tonsilitis is often at- 
tended by severe constitutional disturbance. The symptoms at 
the onset may be as severe as in diphtheria. There may be a 
chill or chilly sensations. The temperature may reach 104° or 
105° in twenty-four to forty-eight hours. There are often head- 
ache, anorexia and insomnia. The patient complains of dryness 
and soreness of the throat and pain on swallowing. Usually 
within three to ^ve days the fever and other symptoms subside 
and recovery is rapid. After the attack there may be marked 
prostration. The prognosis is always favorable. It may be mis- 
taken for diphtheria. 

Parenchymatous tonsilitis, or u quinsy sore throat/ 1 some- 
times called phlegmonous pharyngitis, is an inflammation of the 
parenchyma of one or both tonsils. It may terminate in resolu- 



568 A COMPENDIUM OF PRACTICAL MEDICINE. 

tion, but usually it goes on to suppuration, constituting the dis- 
ease called suppurative tonsilitis or quinsy (Flint and Loomis). 

Causes. — Quinsy is rare in those under twelve years of age, 
"but is more common in youth than in adult life. Certain atmos- 
pheric influences predispose to it. It "runs in families." Scro- 
fula and syphilis favor its development. Exposure almost 
always precedes an attack. One attack predisposes to others. 
Tonsilitis often occurs with scarlet fever, measles, and typhoid 
fever. Follicular tonsilitis with ulceration is usually.preceded 
by disorders of digestion, and seems to depend on this for its 
origin. A relationship has been supposed to exist between the 
ovaries and tonsils, but it is by no means well defined (Bartho- 
low, Flint and Loomis). 

Symptoms. — There may be a chill or chilly sensations at the 
onset, followed by fever, (103° to 105° F.) The tongue and 
throat become dry; there are heat, pain, and swelling in the ton- 
sil; the fluids are often regurgitated through the nostrils. Thick 
mucus is expectorated. The breath is offensive, the jaws are 
often immovable. There is a peculiar nasal tone to the voice. 
The patient is unable to sleep, has a sense of suffocation, and 
sometimes is delirious. In four or five days, something is felt to 
give way in the throat, and suddenly the patient is entirely re- 
lieved by the discharge of fetid yellow pus. Convalescence is 
rapid. The abscess in the tonsil may open at one or at several 
rjoints. Much suffering is experienced (Flint and Loomis). 

Prognosis. — Is always good. Chronic enlargement of the 
tonsil may result. The entire duration of the disease is eight 
days. Death in rare instances may result from suffocation, ex- 
haustion, or cedema glottidis '(Loomis). 

Treatment. — A saline laxative should inaugurate the treat- 
ment unless the bowels are relaxed. Tincture of aconite -root 
(gtt i-iij) may be given every hour or two for the period pre- 
ceeding pus-formation. At the onset, calomel, in the dose of 
three to five grains, is superior to all other remedies. When pus 
has formed quinine is the best agent. Acetanilid and antipyrin 
are good remedies to reduce temperature. Opium or its alka- 
loids should not be given in quinsy. The local treatment is im- 
portant A hot or cold wet pack about the neck affords relief. 



TOXSILITIS — TOOTHACHE. 569 

A gargle of hot milk and water, used every few rninutes, lessens 
inflammation and swelling. Sometimes ice and cold water are 
more grateful. Bicarbonate of sodium in powder, placed on the 
tonsil gives great relief. \Yhen suppuration occurs, warm appli- 
cations are to he preferred. AVhen the tonsils are much swollen 
they may be scarified. \Yhen pus forms it should be evacuated. 
Astringent o^arodes at the onset mav in some cases arrest the dis- 
ease. Loomis savs U I have been able in a lar^e number of cases 

t/ o 

to abort a quinsy by a twenty- grain dose of quinine administered 
at the time of the chill followed by a large dose of bromide of 
potassium/ 1 Guaiacum has long been celebrated for its power 
to arrest tonsillar infianmiation, in scruple doses. Fluid extract 
of ergot is supposed to have specific power to arrest the disease 
(Bartholow and Loomis). 

TOOTHACHE. 

Is a localized dental pain, and varies in character according 
to the part of the tooth involved. A darting pain betokens irri- 
tation and probable exposure of the pulp. A violent, throbbing 
pain points to general infiammation of the pulp. In alveolar 
abscess, the pain is dull and throbbing (Bryant). 

Treatment. — Dentists employ arsenic as an escharotic to 
destroy the exposed sensitive pulp of decayed teeth. A strong 
infusion of capsicum applied on lint to the aching tooth is very 
effective. Chloral, rubbed up with an equal weight of camphor, 
and rubbed gently in externally or put into the cavity of an 
aching tooth, gives prompt relief in some cases. A few drops of 
chloroform on cotton-wool, inserted into the hollow of a decayed 
aching tooth, often gives permanent relief. Equal parts of chlo- 
roform and creasote constitute a useful application in toothache. 
A mixture of equal parts of collodion and carbolic on a small 
piece of cotton -wool inserted into the hollow painful tooth soon 
gives relief. A solution of alum in nitrous ether is said to be an 
effective application in toothache. Dr. Duckworth reports that 
toothache may be quickly allayed by holding a solution of car- 
bonate of soda in the mouth. A drop or two of oil of cloves 
inserted into the cavity of an aching tooth soon stops tin 1 pain. 



,570 A COMPENDIUM OF PRACTICAL MEDICINE. 

Xanthoxylum (prickly ash) is a domestic remedy for toothache 
(Bartholow and Ringer). 

TYMPANITES. 

Is not a disease but a symptom. It is a flatulent distention 
of the bowels. Great prominence of the abdomen due to flatu- 
lent distention of the bowels, is, if at all persistent, very apt to 
be mistaken for ascites. But the large abdomen yields not a 
dull, but everywhere a tympanitic sound and there is no fluctua 
tion. In most cases the gas which causes the distention, is de 
rived from putrefactive or fomentative changes in the ingesta 
The accumulation of gas within the stomach occasions painful dis 
tension, and rarely may cause sudden death. The habit of swol 
lowing air may cause tympanites of the stomach (this corresponds 
to wind- sucking in horses). An habitual tympanites of the 
stomach occasions in some persons, after the ingestion of liquid, 
a succussion sound in walking resembling the sound frequently 
heard in horses. This is a source of much annoyance and morti- 
fication, especially to women. It may be avoided by taking into 
the stomach only very small quantities of liquid at a time. Some 
persons suffer from an habitual tympanites. Females are more 
liable to it than males. 

Treatment : 

jfc Olei terebinthinse ^ij.-viij. 

Olei ricini gij . 

Vitelli ovi no. j . 

Decocti hordei ^viij .-xvj . — M. 

Ft. enema. 
Sig. : Inject into the bowel. — Bartholow. 

J5r Olei terebinthinse 3J. 

Olei olivse ^iss. 

Camphorse gr. xx. 

Decocti a venae gviij . — M. 

Ft. enema. 
Sig. : Inject into the bowel. — Copeland. 

Jfc Pulv. capsici gr. vj.-xxiv. 

Sacchari lactis gr. xxx. — M. 

In pulv. no. xii. div. 
Sig. : A powder every four hours. — Phillips. 



TRICHINOSIS. 571 

TRICHINOSIS. 

Is a parasitic disease. The parasite is called trlcliina spir- 
alis, in the form of a minute worm, measuring about one-thirty - 
fifth of an inch in length, which enters the human system through 
the intestinal tract after the ingestion of trichinous flesh (Loomis). 

Causes. — Trichinosis in human beings results almost exclus- 
ively from eating trichinous pork. The raw flesh is most dan- 
gerous. Sausages, smoked ham, quickly broiled ham, or any 
form of pork that has not been subjected to a moist heat of 170°, 
is liable to induce it. Each trichina may give birth to a thousand 
young (Loomis and Flint). 

Symptoms. — Are first gastro- intestinal and then muscular; 
associated with these there is more or less fever. Nausea, vom- 
iting, vertigo, anorexia and a feeling of malaise come on. There 
is almost always diarrhoea. After a short time there are wan- 
dering pains in the limbs, which become stiff and painful to the 
touch and the muscles are swollen and rigid. In from four to 
ten days oedema of the eyelids perhaps of the entire face occurs. 
The temperature is 101° to 105°; the pulse 110 to 120. There is 
photophobia and movements of the limbs or of the eyes are ac- 
companied by excruciating pain. The pain in the limbs becomes 
so great that the patient cannot sleep. (Edema of the lower ex- 
tremities is common. The perspiration is copious, the diarrhoea 
exhaustive, the limbs are paralyzed and the patient lies in a state 
of utter helplessness. Recovery occurs in from four to five 
weeks after the onset of the disease. Death may occur in the 
fourth week (Loomis and Flint). 

Differential Diagnosis. — Trichinosis may be confounded with 
typhoid fever, but a microscopic examination of small portions 
of the muscular tissue will afford a positive diagnosis (Loomis V 

Treatment. — Preventive treatment consists in eating no pork 
that has not been so prepared as to kill any trichinae that might 
exist. We know of no means of destroying the trichinae after 
they have once entered the muscles. Purgatives may be given 
early in the disease. Good diet, stimulants, quinine and iron 
are of service (Loomis). 



572 A COMPENDIUM OF PRACTICAL MEDICINE. 

TONGUE=TIE. 

Is occasionally met with. It is clue to a tying down of the 
tip of the tongue by the frsenum linguae, which prevents the 
infant from projecting the organ beyond the gums, thereby 
interfering with suckling (Bryant). 

Treatment. — It is easily remedied by dividing the frsenum 
perpendicularly downward behind the gum with a pair of 
blunt-pointed scissors, the point of the tongue being elevated 
with the finger (Bryant). 

TRACHOMA. 

Called also granular conjunctivitis, is characterized by hy- 
pertrophy of the conjunctiva, either in disseminated spots or 
diffused. The trachoma granules are small, rounded masses of 
various sizes. On everting the lids, we find little bodies of the 
size of a rape- seed lying beneath the conjunctiva. The patient 
complains of slight irritation of the lids and inability to use the 
eyes for a long period; the eyes feel weak at night; light is un- 
pleasant; the lids are sticky (Noyes). 

Treatment. — Touch the lids lightly once a day with a crystal 
of sulphate of copper or alum, with solutions of tannin and 
glycerine (gr. x.-xxx. to 5J.), or with a solution of nitrate of 
silver (gr. v. to Sj). The redundant masses of granules may be 
squeezed by forceps (Noyes). 

TYPHOID FEVER. 

Is an acute febrile affection, self -limited, feebly if at all con- 
tagious, and characterized by a peculiar eruption on the abdomen, 
by a form of diarrhoea, by stupor and low delirium, by thicken- 
ing and ulceration of Peyei^s patches, by infiltration and soften- 
ing of the associated mesenteric glands, and by swollen spleen 
(Bartholow). 

Typhoid is the most prevalent of all fevers exeejot malarial. 
It may be developed in all latitudes and in all countries, but it 
prevails more in the temperate zones than in the torrid or frigid. 
The Germans call it abdominal typhus, gastric fever, or ileo- 



TYPHOID FEVEE. 573 

typlms. It is also called common continued fever, enteric fever 
and pytliogenic fever (Looniis ) . 

Morbid Anatomy. — When the disease if fully established the 
blood becomes darker in color and coagulates imperfectly. With 
these blood changes, parenchymatous degeneration takes place 
in the organs and tissues of the body. But the characteristic 
lesions of typhoid fever are seated in the lymphatic structures of 
the intestine namely, Peyer's patches and the solitary follicles. 
Corresponding to the intestinal changes are alterations in the 
mesenteric glands. 

Intestines. — Four stages of the morbid process in the intes- 
tine may be distinguished and they correspond very closely with 
the four weeks of the disease. In the first week of the disease 
there are congestion and inflammation of the mucous membrane 
of the small intestine with a medullary infiltration of Peyer's 
patches and the solitary follicles. As a result of these processes, 
there is hyperemia and swelling of the mucous membranes and 
the affected glands become enlarged and elevated from one to 
two lines above the mucous surface. These glands assume a 
dark- red or reddish -gray color marked with fine white striations 
and present the so-called "shaven beard" appearance. These 
changes begin and are most extensive in the glands nearest the 
ileo-cgecal valve. The number of patches involved varies from 
four to ^ve near the valve to twenty or thirty throughout the 
whole intestine. In the second %ueek the hyperemia and catarrh 
of the mucous membrane subside and the swelling and infiltra- 
tion of the solitary follicles and Peyer^s patches increase. The 
" shaven beard" appearance disappears. During this week ne- 
crotic changes in the swollen follicles and patches take place. 
The casting off of the necrotic tissue results in the formation of 
the typhoid ulcer. In the third week the process of ulceration is 
completed. The entire gland may slough uniformly and at once 
form the complete ulcer. 

Usually the sloughing and removal of the necrotic tissue 
does not take place until the third week of the disease. The 
necrotic process may extend and involve the muscular tissue, and 
end in perforation of the peritoneal covering. These ulcers may 
be developed in the jejunum, ileum, stomach and the large 



574 A COMPENDIUM OF PRACTICAL MEDICINE. 

intestine. In the lower part of the ileum, at the ileo-csecal valve r 
the ulcers are usually of large size and elliptical with their long 
axis corresponding to that of the intestine. In the jejunum, 
stomach and large intestine they are usually round and of small 
size. Sometimes the ulcers are hemorrhagic. Those ulcers re- 
sulting from necrosis of the solitary follicles are round. Cases 
have been described in which the ulcers were fully formed on 
the seventh or eighth day of the disease. In the fourth week the 
process of cicatrization is commenced. It may begin in the 
third week of the disease and continue during convalescence. 
Gradually the swollen edges of the ulcers subside and granula- 
tion tissue springs up from their base. The gland structure is 
never regenerated. These cicatrices have little tendency to cause 
stenosis of the intestinal lumen. 

Perforation of the intestine is liable to occur in one or more 
of the ulcers. It occurs in about one per cent, of the cases of 
typhoid fever, and in about eight per cent, of the deaths from 
this disease. It is most frequent between the third and fifth 
week of the disease. It is rarely caused by the primary slough- 
ing, but is due to secondary ulceration after the separation of the 
slough. The opening in the peritoneal coat may be of consider- 
able size or it may be no larger than a pin's point. Profuse 
hemorrhage may occur from the primary sloughing or from the 
secondary ulceration. 

Mesenteric Glands. — More or less enlargement of the mesen- 
teric glands is always associated with the intestinal lesions. 
They are secondary to the changes in the intestinal glands. The 
enlarged glands vary in size from that of a hazel-nut to a small 
hen's egg. In rare instances these glands slough and cause peri- 
tonitis. 

Spleen. — The organ in which parenchymatous degeneration 
occurs earliest and most extensively is the spleen. It is enlarged 
often two or three times its normal size. The enlargement goes 
on rapidly until the third week, and is due to congestion and to 
hyperplasia of the cellular elements. It is dark-red in color and 
softened. Hemorrhagic infarctions and rupture of the capsule 
of the spleen may take place. These changes in the spleen take 



TYPHOID FEVEK. 575 

place, in a greater or less degree, in ninety -eight cases out of every 
hundred. 

Liver. — The liver is usually somewhat swollen, pale, and 
softened. The hepatic cells are in a condition of parenchymatous 
degeneration. 

Kidneys. — Parenchymatous degeneration of the renal epi- 
thelium is the rule. An acute nephritis may occur. 

Heart. — The heart becomes soft and flabby, and is of a 
grayish or brown color. The parenchymatous changes which 
take place in the heart are more marked than those of any other 
organ except the spleen. The heart loses its normal outline, and 
when removed from the body the walls of its cavities readily fall 
together. Vegetations sometimes form on the valves and chordae 
tendinese of the heart, and in some cases the first sound will be 
absent. 

Lungs. — Changes in the lungs are present in nearly all cases 
of typhoid fever. Congestion and inflammation of the bronchial 
mucous membrane are so constantly present, that Dr. Stokes pro- 
posed to call typhoid fever bronchial typhus. Hypostatic con- 
gestion and pulmonary oedema are common. Pneumonia is a 
frequent complication. 

Larynx. — Ulcerations of the larynx, the mucous membrane 
of the mouth and pharynx may occur. 

Salivary Glands. — The salivary glands enlarge, become 
firm and tense, and there are a proliferation and parenchymatous 
degeneration of their cells. These changes cause a diminished 
salivary secretion which is so marked and constant in typhoid. 
Abscess of the parotid gland may occur in typhoid. 

Brain and Nervous System. — No changes have been dis- 
covered in the central nervous system to explain the mental dis- 
turbance which characterizes this disease. But it is reasonable 
to infer that in a disease, where such severe functional distur- 
bances exist, there must be constant and definite parenchymatous 
changes. 

Stomach. — Softening and degeneration of the glandular 
structure takes place in the stomach and this gives rise to dis- 
turbance of digestion. 



576 A COMPENDIUM OF PRACTICAL MEDICINE. 

Muscles. — The voluntary muscles undergo a hyaline or 
waxy degeneration (Flint and Loomis). 

Causes. — Typhoid is endemic in every quarter of the globe. 
It is possible for it to prevail as an epidemic. It prevails more 
in the autumn than in any other season of the year and for this 
reason it has been called autumnal fever. It is stated that a 
warm, dry summer favors the occurrence of the disease in the fol- 
lowing autumn. Age must be regarded as a predisposing cause 
of typhod fever. It occurs most frequently between the ages of 
fifteen and twenty- five, next between ten and fifteen and next be- 
tween twenty -five and thirty. It is rare in infancy and after 
fifty. As a rule persons are in good health when attacked. 
Pregnant women when attacked with typhoid fever generally 
abort. Some persons are more susceptible to the typhoid pois- 
on than others. The typhoid bacillus is the specific cause of 
the disease. This micro-organism may grow readily outside of 
the body, as in the soil, on vegetables, milk, meat- infusions, or in 
liquids containing sufficient nutriment, and by the formation of 
spores it may preserve its vitality for a long time. There is no 
evidence that the typhoid bacillus exists in the exhalations from 
the patient. Typhoid fever is communicable but not in the same 
way as the strictly contagious diseases, such as small -pox, scarlet 
fever, etc. 

Washerwomen frequently contract the disease from washing 
linen soiled with typhoid excreta. It is probable that the 
typhoid stools are the chief source of infection of a locality in 
which the disease becomes endemic. The following instance 
proves this: A stranger ill with typhoid fever came to a little 
settlement called North Boston, consisting of nine families. Up 
to this time typhoid fever had never been known in that neigh- 
borhood. In a few days the stranger died, and in a month, more 
than half the population, numbering forty-three, had been 
affected, and ten died. Of the nine families, one family escaped 
which obtained its water from a source different from the others, 
which used a common well. The typhoid bacilli have been 
found in the drinking-water of regions where typhoid was pre- 
vailing as an epidemic. Such water may be perfectly clear and 
apparently pure. Sometimes the water of a well used for drink- 



TYPHOID FEVER. 577 

ing purposes becomes infected by a communication or leakage 
between it and a privy- vault, cess- pool, sewer, or drain. A 
number of typhoid epidemics have been traced to the milk- 
supply. Here it is probable that the vehicle of infection is the 
water used in cleansing the cans or in diluting the milk. The 
period of incubation varies from fourteen to twenty days (Flint 
and Loomis). 

Symptoms. — Typhoid fever is developed gradually as a rule, 
and is insidious usually in its approach. The patient feels 
uneasy and uncomfortable, has no pain, but feels that he is about 
to be sick. The premonitory syrurjtoms are : Headache, more 
or less aching of the limbs, u a tired feeling all over," chilly sen- 
sations, loss of appetite, occasional nausea and vomiting, epistaxis 
in most cases, diarrhcea or constipation. By the fifth or sixth 
day the patient is compelled to take to his bed. Countenance 
has nothing peculiar at first, except it is flushed, but later the 
expression is dull and there is an appearance of stupidity. By 
the second week, there is a pale, olive, leaden look, and usually 
there is a small rose -colored spot in the centre of each cheek. 
The face does not assume the dark mahogany color seen in 
typhus, but in the advanced stages of the fever it has more of 
the hectic flush of phthisis. The whole surface presents a slight 
capillary congestion, like that produced by the action of cold, 
and in some cases the hue of the surface is slightly dusky. This 
capillary congestion is caused by paresis of the peripheral 
arteries. 

Nervous System. — The symptoms referable to the nervous 
system are: 1. Headache which is more or less complained of 
during the first week, but usually ceases during the second week. 
It is not violent, but a dull heavy pain. Pain in the back and 
limbs, and a general aching of the whole body is also com- 
plained of. 

Delirium is manifested in the majority of cases. The de- 
lirum rarely comes on before the second week of the fever and is 
most active at night. The delirum is usually the "low-mutter- 
ing," but it may be violent. Persisting, active delirium is an 
extremely unfavorable symptom. The mental condition is char- 
acterized by hebetude, indifference, and inanimation. Sensibility 



578 A COMPENDIUM OF PEACTICAL MEDICINE. 

is diminished and perception blunted. The state in which the 
patient may be said to be both sleeping and wakeful, is called 
coma-vigil. Other nervous symptoms are: grasping at invisible 
objects or carphologia, pulling up of the bed linen, visible 
twitchings of the muscles of the face and of the extremities, sub- 
sultus tendinum, rigidity of the muscles of the neck or extremi- 
ties and convulsions. These denote gravity of the disease. 

Digestive System. — Anorexia is the rule. Thirst is promin- 
ent. The tongue from the very outset is covered with a light, 
white coat. At the end of the first week it becomes red upon 
its sides and tip and dry in centre. In the second and third 
weeks the tongue becomes more heavily coated, the coating 
becomes brown and dry, and sordes collect on the teeth. At any 
period in the course of the disease the tongue may suddenly clear 
off and present a shiny red, beef -colored appearance. The tongue 
and lips may become dry, cracked, and fissured and bleed. 
Nausea and vomiting are quite common during the first week of 
the fever. Diarrhoea is one of the characteristic symptoms, but 
is not always present. The discharges are of a yellowish -green 
color, described as "pea-soup discharges.'" Sometimes they 
resemble coffee- grounds. The diarrhoea usually appears the 
second week, but in some cases it is present at the very outset of 
the disease and in others it does not appear until the third week. 

Intestinal Hemorrhage. — Hemorrhage from the bowels 
occurs in about live per cent, of the cases. It may be slight, 
moderate, or profuse. These hemorrhages usually occur in the 
second and third weeks, and are accompanied by a sudden fall 
of temperature. 

These three symptoms, namely, meteorism, or tympanites, 
iliac tenderness and gurgling, especially the two former con- 
joined with diarrhoea and ochre -colored discharges — form a 
group of symptoms highly diagnostic of this form of fever. They 
may all be absent. 

Perforation. — Perforation of the intestine takes place in be- 
tween one and two per cent, of all cases, and in ten per cent, of 
fatal cases. Jt takes place late in the disease or during convales- 
cence and sometimes even after apparent recovery. It occurs as 
often in mild as in severe cases. Perforation gives rise to per- 



TYPHOID FEVER. 579 

itonitis, which is generally developed abruptly. The sudden oc- 
currence of pain diffused over the abdomen, increased tympanitic 
distension rigidity of the abdominal walls, great prostration, a 
rapid, feeble pulse, a sunken anxious expression of countenance, 
nausea and vomiting quickly followed by coldness and blueness 
of the extremities and other signs of collapse point to peritonitis 
from perforation. Peritonitis does not invariably denote perfora- 
tion. It may be caused by rupture of a mesenteric gland. 

Shin. — Of the symptoms referable to the skin, the most im- 
portant is a characteristic eruption. It makes its appearance be- 
tween the sixth and twelfth days of the disease, and remains visi- 
ble from eight to fourteen days. It consists of isolated papules 
generally limited to the trunk, of a rose or pink color, called by 
Louis lenticular rose -colored spots. The spots are slightly ele- 
vated and the redness momentarily disappears on light pressure. 
The number of spots varies from two or three to many. Each 
spot remains visible for three days and then disappears. The 
eruption is not invariably present. Jenner states that he found 
the eruption present in one hundred and forty- eight out of one 
hundred and fifty -two cases. Bed-sores and gangrene are liable 
to occur in situations exposed to pressure. 

Respiratory System. — Slight or moderate cough is almost 
invariably present, proceeding from sub -acute bronchitis. 
Pneumonia is a frequent complication. Hypostatic congestion 
and oedema of the posterior portions of both lungs are incident 
to the feeble circulation in the latter part of the disease. 
JEpistaxis is a symptom of diagnostic value early in the disease. 

Pulse. — The danger is usually considerable if the pulse for 
many days exceed 120 per minute. A sudden and considerable 
increase of frequency of the pulse often denotes the occurrence 
of pneumonia or peritonitis. The pulse is quick and vibratory 
and often dicrotic. Failure of heart-power is indicated by an 
increase in the frequency and feebleness of the pulse. 

Temperature. — There is a daily increase of temperature for 
the first i\xe or eight days. This gradual rise of temperature 
from day to day during the first week is diagnostic of typhoid 
fever. There are morning: remissions and evening exacerbations. 
The temperature of typhoid fever does not always pursue the 



580 A COMPENDIUM OF PRACTICAL MEDICINE. 

typical course. The temperature may reach its acme by the- end 
of the third day, and may be of a remittent or intermittent type. 
A high elevation of temperature in the morning, 106° to 108° F., 
indicates the approach of death. A sudden and considerable fall 
of temperature, other symptoms not denoting convalescence or 
improvement, is unfavorable. This often indicates hemorrhage 
from the bowels. 

Special Senses. — The eye assumes a dull expression and the 
pupil is dilated. The sense of hearing is always more or less 
impaired. The sense of taste is perverted and patients are unable 
to distinguish between bitter and sweet. Hyperesthesia may be 
present in hysterical females. 

Emaciation is more marked and rapid in typhoid than in 
any other form of fever.' 

Mild Typhoid Fever. — In the mild type, the fever runs its 
regular course but is of low grade. Some of these cases are so 
mild that the patients are not confined to the bed, and are called 
u walking cases " of typhoid fever. All the symptoms of these 
cases are mild. These patients should take to the bed and re- 
main there until convalescence is established. The abortive form 
of typhoid fever is ushered in with all the symptoms of a typical 
case; but by the end of the second week the patient passes on to 
a state of complete convalescence. If only a moderate amount of 
typhoid poison is introduced into the system, a mild or an abor- 
tive type of fever will be developed. 

Duration of Typhoid. — Of forty-two cases ending in recovery 
analyzed by Flint the average duration was sixteen days. The 
maximum duration was twenty- eight days and the minimum five 
days. Of forty-five fatal cases of Flint's the mean duration was 
a fraction more than fourteen days, the maximum being twenty 
and the minimum nine days. The average duration of conva- 
lescence is between one and two weeks. A temporary fever often 
accompanies the change of diet from liquid to solid animal food. 

Relapses of typhoid fever sometimes occur. A return of the 
fever may take place after ten days to two weeks from the date 
of convalescence, and the patient passes through a secondcareer, 
the eruption and other characteristic symptoms being reproduced. 
The duration of the second career is usually shorter and the 



TYPHOID FEVER. 581 

severity greater than the first, but a fatal termination is rare. 
The cause of the relapse is not known. Some hold that all re- 
lapses depend upon a new infection. Others hold that a part of 
fche typhoid poison has remained in the system, undeveloped dur- 
ing the primary attack. In some cases, apparently, the relapse 
has been brought on by indiscretion in diet, or exercise (Bartho- 
low. Flint and Loomis). 

Differential Diagnosis. — The presence of fever with evening 
exacerbations and morning remissions, headache, diarrhoea, ab- 
dominal tenderness, and the presence of the characteristic rose- 
colored spots are sufficient for a diagnosis. Typhoid fever may 
be confounded with typhus and relapsing fevers, continued m<i- 
la/rial fever, acute tuberculosis, pyaemia, septicemia, pneumonia, 
gastro- enteritis, trichinosis, diffuse parenchymatous hepatitis, 
and acute meningitis. 

Typhus fever is sudden in its advent, while typhoid is slowly 
developed. 

In typhus fever, there is a chill at the commencement, and 
severe j:>ain in the head; great muscular weakness; the temj^era- 
ture rises rapidly to 104° or 105° F., before the end of the second 
day: emaciation is slight; the eruption appears upon the arms 
and chest on the fifth or sixth day; the spots are numerous and 
of a dark pinkish hue; constipation is the rule; the abdominal 
-ymptoms of typhoid are never present in typhus fever. Typhus 
fever is contagious, typhoid fever is non-contagious. Typhus is 
generally epidemic, typhoid is always endemic. In typhus, the 
dusky face, contracted pupils, and peculiar smell will distinguish 
it from typhoid. 

In typhoid, the slow invasion, the wt step-ladder' 1 rise in tem- 
perature, the eruption, the characteristic diarrhoea, and the con- 
tinuance without remission or intermission will be sufficient to 
distinguish it from relapsing fever. 

Acute miliary tuberculosis is to be discriminated from 
typhoid by the notable frequency of the respirations, the prom- 
inence of the cough, haemoptysis in some cases, the abundance of 
sub-crepitant rales; by marked lividity and presence of choroid 
tubercle-, and by the absence of the abdominal and other events 
of typhoid. 



582 A COMPENDIUM OF PRACTICAL MEDICINE 

Acute meningitis is distinguished from typhoid by more in- 
tense headache by intolerance of light and sounds, early and ac- 
tive delirium by frequent vomiting, by rigidity of the muscles at 
the back of the neck and by somnolency and coma succeeding 
the delirium and by depressed abdomen. In pycemia and sep- 
ticaemia the surface of the body has a jaundiced hue, there are 
no spots, the fever is irregular, recurring chills followed by pro- 
fuse sweatings take place early. Pneumonia with typhoid symp- 
toms is sometimes mistaken for typhoid fever. The physical 
signs, the cough, the characteristic pneumonic expectoration, no 
eruption, etc., will distinguish it from typhoid (Bartholow, Flint 
and Loomis). 

Prognosis. — Death may occur at any stage of this fever. The 
average mortality from typhoid is about ten per cent. The prog- 
nosis is always bad in those who are fat. Complications render 
the prognosis more unfavorable. Death rarely occurs before the 
fourteenth day. The direct causes of death are: toxcemia, 
asthenia, suppression of the urine, oedema of the lungs, exhaustive 
diarrhoea, intestinal hemorrhage or perforation and peritonitis 
(Bartholow, Flint and Loomis). 

Treatment. — The typhoid stools should be thoroughly disin- 
fected as soon as passed, and should never be emptied into a 
privy or water-closet, but into trenches. The bed- linen should 
be disinfected and kept scrupulously clean. Typhoid fever 
cannot be aborted by any remedy known. The patient should 
be placed in a large and well- ventilated apartment. Only the 
nurse and attendants should be allowed in the room. Milk is 
the proper diet, and fruits are not to be allowed in any case. 
Frequent sponging of the body with tepid water will be of 
service. When the temperature reaches 104° or more, sponge 
the body with cold water. Of the internal antipyretics, Loomis 
prefers antifebrin in five to ten grain doses three times daily. 

Stimulants. — When signs of failure of heart-power begin to 
manifest themselves, stimulants are indicated. If under their 
use the tongue becomes dry, the patient more restless, the deli- 
rium more active, the temperature higher, and the pulse more 
frequent, it is very certain that stimulants are contraindicatecl ; 
and vice versa. Bartholow's experience is, that the administra- 



TYPHOID FEVER TYPHUS FEVEPv. 583 

tion of iodine has a favorable effect on the course of the disease, 
and he has used with decided success the combination of iodine 
and carbolic acid (jfc Tinct. iodi 5ii., acid carbolici 5i. — M. Sig.: 
One to three drops three times a day). 

Diarrhoea. — For the diarrhoea, there is but one remedy 
which can be relied upon, and that is opium. 

Tympanites. — Turpentine stupes to the abdomen, and tur- 
pentine internally and by rectum will give relief to the tym- 
panites. 

Intestinal Hemorrhage. — Can best be controlled by an ice- 
bag to the abdomen, and the administration of opium in small 
doses frequently. 

Peritonitis. — Is best treated by opium. 

For the bronchitis, carbonate of ammonia is very effective . 
For the active delirium, opium and sedative remedies. For bed- 
sores, cleanliness and the proper dressings (Bartholow, Flint and 
Loomis). 

TYPHUS FEVER. 

Is a febrile affection, self -limited, contagious, usually pre- 
vails epidemically, and characterized by profound adynamia, a 
peculiar petechial eruption, favorable cases terminating by crisis 
at the end of the second week. It has received a great variety 
of names, such as ship fever, hospital fever, jail fever, camp) fever, 
petechial fever, putrid fever, Irish ague, brain fever, spotted fever, 
continued fever, etc. (Bartholow and Loomis). 

Morbid Anatomy. — In typhus the abdominal lesions which 
are characteristic of typhoid fever are wanting. The small in- 
testine may have the shaven -beard appearance. There are no 
lesions peculiar to the disease and constantly present. The spleen 
is usually large, soft, and of a dark, bluish -red color. The blood 
is unnaturally dark and fluid. Hypostatic congestion of the 
lungs, bronchitis, lobular pneumonia, pulmonary oedema, cere- 
bral congestion, and parenchymatous degenerations are frequent 
(Flint and Loomis). 

Causes. — Typhus is seen in this country only at our seaport 
towns. It depends upon a specific poison, of whose exact nature 
we are ignorant. This poison is communicated from the sick to 



584 A COMPENDIUM OF PRACTICAL MEDICINE. 

the healthy mainly by personal contagion — that is, the recipient 
of the poison must be brought in contact with the exhalations of 
the infected person. Where there is free ventilation, contagion 
is confined to narrow limits. Typhus poison passes into the body 
mainly through the respired air. This disease is not indigenous 
to this country. It is imported from Ireland, Italy, and Russia, 
which seem to be the great endemic centres. 

It has been proved by actual experiment that the contagious 
distance of small -pox in the open air, does not exceed two and 
one -half feet and it would seem that the contagious distance of 
typhus fever is even less. It requires the concentration of the 
poison and prolonged exposure to render it infectious. The per- 
iod of incubation is about fourteen days. A single patient in a 
spacious, well -ventilated apartment seldom communicates the 
disease. Typhus fever prevailed in New York City as an epi- 
demic in 1861 to 1864; 1428 cases were admitted into Belle vue 
Hospital during this time (Bartholow, Flint and Loomis). 

Symptoms. — Its advent is usually sudden. As a rule, the 
onset is marked by a distinct chill, followed by a severe and 
steadily increasing headache and by pain in the back and limbs 
and by great muscular weakness. The face has a dusky or 
dingy hue. In some cases there are coma -vigil delirium, stupor, 
p> in -hole pupil and convulsions. The tongue is covered with a 
thick brown or black coating. Sordes collect on teeth and lips. 
A characteristic eruption appears about the third to the fifth 
day. It is a macular not a papular eruption. The spots become 
of a dull, dingy or dark- red color, and do not disappear on pres- 
sure. They are smaller than the papules of typhoid. They do 
not come and go like the rose papules of typhoid. The odor 
from typhus patients is stated to be characteristic. The temper- 
ature the first day may rise to 104° or 105° F., and remain so the 
first week. The pulse ranges from 100 to 130. Loss of muscu- 
lar strength is so great that the patient is unable to turn in bed. 
The duration of typhus is about fourteen days. One attack 
serves to exempt from future attacks (Bartholow, Flint and 
Loomis). 

Prognosis. — In certain epidemics the mortality runs as high 
as forty to fifty per cent. Average fifteen per cent. 



ULCERS AXD SORES. 5S5 

Treatment. — The same means of treatment pursued in typhoid 
are equally applicable to typhus fever (See treatment of ty- 
phoid) (Bartholow). 

ULCERS AND SORES. 

Ulceration is the result of an inflammatory process by 
which a sore or chasm is produced. An ulcer is a loss of sub- 
stance without a tendency to heal. An ulcer is molecular necro- 
sis, the nutrition of the tissue being so disturbed as to allow the 
chemical or disintegrating changes to have their way. A sore is 
a chasm, a solution of continuity, caused by ulceration, the result 
of injury or otherwise, upon an external or internal surface of 
the body. When a sore is being formed or is spreading by the 
process of ulceration, an ulcer is said to exist; when the ulcera- 
tion has ceased, a sore remains (Bryant and Dennis). 

Situation. — Ulcers are found upon the skin, mucous mem- 
brane, serous membrane, and inner wall of blood-vessels (Dennis). 

Varieties According to Condition of Ulcer. — Ulcers may be 
healthy, inflamed, weak, indolent, sloughing from excess of in- 
dolence, or irritable. 

Causes. — Are predisposing and exciting. Predisposing causes 
are: 1. Age. 2. Malnutrition. 3. Poor blood supply. 

The exciting causes are: 1. Injury — mechanical, chemical, 
and thermic. Mechanical injury, as a splint, pressure, blows, 
etc. Chemical injury, as the extravasation of urine. Thermic 
injury, as frost-bite, burns, lightning, etc. 2. Disturbances in 
the circulation, as varicose veins, atheroma of the vessels, weak- 
ened heart action. 3. Disturbances in the nutrition. These may 
be local or general. Under local disturbances are oedema, con- 
gestion, hemorrhage and inflammation. Under general disturb- 
ances are syphilis, scurvy, gout, rheumatism and tuberculosis. 
4. Disturbance of innervation, associated with diseases of the 
spinal cord, as bed-sores, etc. We find ulcer in the stump due to 
innervation. 

Causes of ulcers on the leg are due to traumatism, syphilis, 
or varicose veins. Traumatic and varicose ulcers arc situated in 
the lower third, and' syphilitic ulcers are situated in the upper 
third of the leg, as a rule (Bryant and Dennis). 



586 A COMPENDIUM OF PRACTICAL MEDICINE. 

Description of an Ulcer. — The base may "be shallow or deej^; 
the margin may be everted, undermined, or indurated; the dis- 
charge may be muco-purulent or bloody. 

Treatment, — 1. Relieve the congestion. The best way is to 
take a sharp knife and cut the indurated edge. 2. Encourage 
healthy granulations by an antiseptic poultice. 3. Elevate the 
limb and so encourage the circulation. We cannot cure an ulcer 
without rest. Stimulate granulations by balsam of Peru, aro- 
matic wine, cinchona bark, iodoform, bismuth, or oxide of zinc. 
Inquire into the constitution of the patient. If he has syphilis, 
gout or tuberculosis, you must treat these diseases. If the pa- 
tient suffers from varicose ulcers support the blood-vessels per- 
manently by elastic stockings, if it returns ligate the veins twenty 
to forty times. 

Shin-grafts may be used. Take the skin from the thigh and 
plant it over the ulcer (Bryant and Dennis). 

URAEMIA. 

By uraemia is understood the accumulation in the blood of 
excrementitious substances of the urine. 

Causes. — The primary cause is a failure of the kidneys to 
perform their normal function of elimination, and the consequent 
accumulation in the circulation of some or all of the poisonous 
elements of the urine. This condition may occur in the course 
of any disease in which suppression of the renal secretion takes 
place ; but it is more frequent in acute Bright's disease 
(Loomis). 

Symptoms. — Acute uraemia is usually preceded by certain 
signs, such as oedema in various parts of the body, restlessness, 
or an almost irresistible desire to sleep, vertigo, headache, deli- 
rium, nausea, vomiting, diarrhoea and impaired vision. The 
countenance has a pale, waxy or dingy appearance, and the urine 
is scanty, high-colored, bloody, albuminous, and contains casts. 
The convulsions may consist of a single paroxysm, and may simu- 
late epilepsy. There is a strong urinous odor emanating from the 
perspiration. The temperature may be as high as 107° F. 

Urcemic coma may come on gradually or suddenly. The 
patient may be easily aroused. Urcemic coma is always accom- 



URAEMIA URTICARIA. 587 

panied by stertor. The stertor is peculiar; it is not the " snor- 
ing " of apoplexy, but a sharp, hissing sound. The respirations 
are at first accelerated but they soon become slow and labored. 
After a time the temperature falls below the normal standard; 
the face is pale (Loomis). 

Differential Diagnosis. — Uraemia may be mistaken for epi- 
lepsy, cerebral apoplexy, hysterical convulsions. In epilepsy 
the temperature is not elevated. The initial cry and corpse -like 
pallor of the face in epilepsy are wanting in uraemia. In cere- 
bral apoplexy coma always precedes convulsions. In hysterical 
convulsions the patient falls with a scream into a convulsive con- 
dition and afterwards passes a large quantity of pale urine 
(Loomis). 

Prognosis. — Will depend upon the amount of the poison in 
the system. 

Treatment. — Diaphoresis, by the hot-air baths and by the 
use of pilocarpin is of service. Digitalis acts efficiently — is 
diuretic without stimulating the kidneys. It increases the power 
of the heart's action. The diminished secretion of urine is due 
to obstruction in the capillary circulation of the kidneys. Digi- 
talis, by increasing the heart power, overcomes such obstruction. 
Chloroform is not a good remedy in uraemia. Loomis believes 
morphine administered hypodermieally to be the most efficient 
remedy for the treatment of uraemia. It arrests muscular spasm. 
It establishes profuse diaphoresis. It facilitates the action of 
cathartics and diuretics. Dry and wet cupping over the loins 
aid in establishing the renal function (Loomis). 

URTICARIA. 

Called also hives and nettle-rash, is an ephemeral eruption 
of the skin, with wheals and itching, from malassimilation, etc. 

Causes. — The cause may be neurotic. The vasomotor nerves 
are principally at fault. This vaso-motor nerve disturbance may 
result from direct irritation of the skin, or may be reflex, arising 
from the irritation of distant organs and tissues. The sting of 
the common nettle is the most familiar instance of local irrita- 
tion. It is often called forth, in those who are predisposed, by 



588 A COMPENDIUM OF PRACTICAL MEDICINE. 

scratching the skin, or by the bite or sting of insects, such as the 
nea, the bug, the mosquito and the. wasp. The washing of the 
face with warm water often brings out hives. The internal 
causes which may produce nettle-rash by reflex action are: irrita- 
tion of the uterine nerves; in some persons mental emotion; in- 
digestion, certain kinds of food, such as oysters, crabs and lob- 
sters, nuts, onions, pork, sausages, and medicines, such as valerian, 
copaiba, cubebs, turpentine and quinine (Anderson). 

Symptoms.— The rash is familiar to all. The centre of each 
wheal is pale, while the periphery is red. The rash comes out 
with great rapidity, and may disappear in a few hours 
(Anderson). 

Treatment. — Discover and remove the cause or causes. A 
sharp purge is of use. Atropia and bromide of potassium are 
sometimes useful. Locally the parts may be sponged with vine- 
gar and water, or with a lotion of carbolic acid (Anderson). 

VAGINISMUS. 

Called also vulvismus, is a spasmodic contraction of the 
muscles of the pelvic floor — not of the sphincter vaginae muscle 
alone. It is seen alike in single and in married women, and is 
caused by violence in sexual intercourse, as when, in a newly 
married couple, there is some difficulty of entering the vagina, 
and repeated attempts set up an irritation resulting in reflex 
'contraction whenever the penis strikes the anterior margin of 
the perinasum. It is sometimes seen after child-birth caused by 
injury to the pelvic floor. It may be caused by local disease of 
the parts, or it may be due to some disease of the spinal cord. 
The spasm of the muscles is usually accompanied by pain, often 
severe, and rendering the accomplishment of the sexual act not 
only difficult, but impossible (Morris). 

Varieties. — Vaginismus inferior, where the muscles of the 
pelvic outlet alone are involved, and vaginismus superior, where 
the levator ani muscle participates in the contraction; the last is 
a rare affection, and particularly that form where the latter 
muscle only is at fault. This variety sometimes comes on at the 
cud of the sexual act, and the penis may be grasped by its con- 
traction and retained in the vagina for some time. 



vulvitis. 589 

Treatment. — Discover and remove the cause. If an irritable 
hymen is the cause of the trouble, the patient should be ether- 
ized and the hymen dissected out. If no inflammation is present 
gradual dilatation of the vagina does good. 

VULVITIS. 

Is an inflammation of the vulva. It may be either ca- 
tarrhal, follicular, diabetic or aphthous. 

Cause. — /. Of Catarrhal Vulvitis. — Want of cleanliness: 
gonorrhoea, exposure to cold; extension of inflammation from 
other parts: masturbation. 

Symptoms. — Those of an ordinary catarrhal inflammation, 
viz: swelling, redness, heat, pain and dryness of the parts, fol- 
lowed by increased discharge. 

Treatment. — The parts must be kept perfectly clean and 
warm hip-baths should be freely employed. Dusting with bis- 
muth subnitrate and borated cotton between the labia are of 
service. If the disease be of specific origin (see vaginitis). 

II. Follicular vulvitis is that form in which the sebaceous 
follicles are involved. 

Treatment. — The best treatment consists in warm sedative 
applications, warm baths, and alkaline washes. 

Ill Diabetic Vulvitis. — Is dependent upon the presence 
of a fungus developed from the sugar in the urine, and spreading 
from the orifice of the urethra to the vulva. The parts become 
dry and hard and of an intensely red color. The affection is 
attended with intense and very troublesome itching. 

Treatment. — The general condition of the system must be 
treated as well as the local (Morris). 

IV. Aphthous Vulvitis. — Is a disease of childhood follow- 
ing the exanthemata, or any debilitated condition of the system. 

Treatment. — Constitutional remedies are as important as 
local means. Cod-liver oil, quinine, and iron should be given 
and the most scrupulous local cleanliness insured (Morris). 



590 A COMPENDIUM OF PRACTICAL MEDICINE. 

VARICOSE VEINS. 

Are an enlarged and tortuous state of the veins, which are 
usually thickened, rigid, and formed into irregular pouches. 

Situation. — They are most frequently seated on the lower 
extremities, scrotum and rectum. Varicose veins of the leg are 
accompanied by pain, weight, and fatigue on taking exercise; 
they cause ulcers and excoriations of the skin; they sometimes 
burst, causing profuse hemorrhage, and occasionally blood clots 
in the veins, which may terminate in an abscess. 

Treatment. — The palliative treatment consists in applying 
strips of leather over the part or a common roller or an elastic 
stocking, which should be applied in the morning before the 
patient rises. For the radical cure many methods have been 
devised (Morris). 

VARICOCELE. 

Is a varicose state of the veins of the spermatic cord. It is 
more common on the left side. 

Treatment. — Keep the bowels open; wash the scrotum fre- 
quently with cold water; support the scrotum with a suspensory 
bandage. For the radical cure, it is recommended to pass a 
ligature subcutaneously. Operations on the veins are always 
attended with some risk. Many surgeons cut down on the veins 
and ligate them with cat-gut (Morris). 

VERTIGO. 

Has been well defined as the consciousness of disordered 
equilibration. It is not properly a substantive disease, but may 
be the only symptom of the morbid state to which it is referable. 
It is a subjective state, in which the individual affected, or the 
objects about him, seem to be in rapid motion, of a rotary, circu- 
lar, or to -and- fro kind. In common language vertigo is known 
as dizziness. It may be momentary or of long duration (Bar- 
tholow and Loomis). 

Causes. — Vertigo is a purely functional affection. It has 
been divided into ocular, aural, stomachic, nervous, epileptic, 
cardiac, cerebral and gouty. 



VERTIGO. 591 

I Paralysis of a single muscle may cause ocular vertigo. 

II. Aural vertigo is named after its discoverer — Meniere's 
disease, and may be caused by disease of the semicircular canals, 
or other ear troubles. 

Ill Gastric vertigo is the most common, and is an almost 
invariable attendant on dyspepsia and hepatic disorder. 

IV. Nervous vertigo is induced by physical or nervous 
excesses, and Ramskill ranks vertigo from overwork as next to 
gastric in frequency. It is also caused by excessive use of tea, 
coffee, tobacco and alcohol. 

V. Epileptic vertigo precedes an epileptic seizure. 

VI. Cardiac vertigo is a condition of anaemia of the brain 
and is closely allied to fainting. The subjects of cardiac vertigo 
have a swimming sensation in the head, darkness falls on the 
eyes and they become chilly and weak. It is associated with 
fatty heart and dilatation of the right cavities. 

VII Cerebral vertigo occurs as a symptom in cerebral 
anaemia and cerebral congestion; in meningitis, in tumor of the 
brain; in abscess of the brain; in cerebral hemorrhage; in scler- 
osis of the brain; in chorea, hypochondriasis and chronic alco- 
holism. 

VIII. Gouty vertigo is due to the blood changes which 
characterize the gouty diathesis. The vertigo of the aged is a 
result of disordered cerebral circulation produced by the senile 
condition of the heart and vessels. Chronic malarial infection 
may induce vertigo (Bartholow and Loomis). 

Symptoms. — The sensation may be that of objects moving 
around the patient, or of the patient moving around objects 
which remain stationary. There is no loss of consciousness. 
Nausea, vomiting, and ringing in the ears are frequent. The 
first symptom in ocular vertigo will be the running together of 
the letters on the page, headache, nausea, and pains in the eyes. 
In Meuiere's disease, tinnitus aurium accompanies the vertigo. 
After the attack of vertigo passes off deafness remains. Gastric 
vertigo is accompanied by dyspeptic symptoms, nausea, pyrosis, 
heartburn, flatulence, diarrhoea, or coustipation. The mental 
state is often deplorable, and true melancholia may ensue. 



592 A COMPENDIUM OF PRACTICAL MEDICINE. 

Nervous vertigo is apt to occur after excessive mental effort 
(Loornis). 

Treatment. — Gastric vertigo demands the treatment given 
under the head of dyspepsia. In ocular vertigo, rest for the eyes 
and proper glasses will remove it. In aural vertigo, full doses 
of bromide of potassium are of service. In nervous vertigo, iron, 
quinine, strychnine, and the removal of the cause are sufficient. 
The vertigo of old age is benefitted by the bichloride of mercury 
and tincture of iron, with small doses of Burgundy wine (Loomis.) 

VOMITING. 

Is not a disease but a symptom in a large number of dis- 
eases. As a symptom it often demands treatment. 

Treatment. — Tablespoonful doses of iced champagne every 
fifteen minutes will sometimes arrest the vomiting of pregnancy, 
of sea- sickness, of cholera, yellow fever, etc. A little chloroform 
(IHij.-IHv.) dropped on sugar and swallowed, will remove some 
kinds of nausea and vomiting. 

The bromides are serviceable in cerebral vomiting, and in 
cholera infantum in children, and in some cases of reflex vom- 
iting. 

Chloral is highly useful in vomiting of sea- sickness, cholera, 
and reflex vomiting. 

A minim of wine of ipecac, given every half hour or hour 
in a little water, will sometimes relieve the vomiting of preg- 
nancy, vomiting of drunkards, of migraine, etc. 

Drop doses of Fowler's solution, given before meals, will 
stop vomiting of irritative dyspepsia, of pregnancy, of chronic 
gastric catarrh, etc. 

Hydrocyanic acid can be prescribed in the vomiting of acute 
stomach troubles. 

Pepsin, milk and lime-water, and bismuth are proper in the 
vomiting of indigestion, of stomach inflammation, of acidity and 
of acute intestinal disorders. 

Calomel in very minute doses, every half hour or hour, will 
stop some kinds of vomiting. 



VARICELLA. 593 

Cerium oxalate, mix vomica and carbolic will in certain 
cases control vomiting. Counter -irritation at epigastrium often 
allays vomiting (Ringer and Bartholow). 

VARICELLA. 

Known in common language as chicken-pox or swine-pox, is 
a febrile affection, characterized by the appearance of a vesicular 
eruption with the first elevation of temperature, the vesicles 
drying up and falling off in from three to five days. It has been 
called spurious variola. Varicella is the shortest and mildest of 
the eruptive fevers (Bartholow and Smith). 

Causes. — It is due to a specific poison. It is highly contag- 
ious, so that few children escape who are exposed to it. It is a 
disease of childhood. It occurs sporadically and epidemically. 
It attacks the same individual but once. Inoculation has given 
negative results. The period of incubation varies from eight to 
seventeen days (Bartholow, Loomis and Smith). 

Symptoms. — Twenty -four hours preceding the eruption 
there is usually lassitude and a feeling of malaise. The eruption 
generally appears first on the body then on the head. About the 
second day vesicles may appear upon the tongue, lips and palate. 
The vesicles appear in crops. They vary in size from a pin's 
head to that of a pea, or even larger, and contain a clear watery 
and sometimes yellowish fluid. The number of vesicles vary 
from ten to a thousand. The duration of the disease is eight or 
ten days (Bortholow, Loomis and Smith). 

Differential Diagnosis. — Varicella may be mistaken for vario- 
loid. The stage of invasion of varioloid is longer than the stage 
of varicella. The mildness of the symptoms in varicella is diag- 
nostic. The vesicular character of the eruption from the start is 
characteristic of varicella. In varioloid the vesicles are preceded 
by papules. In varioloid the eruption appears first on the face, 
in varicella it appears first on the body. The umbilicated ap- 
pearance of the vesicles is wanting in varicella (Flint). 

Treatment. — Varicella claims no treatment, Rest in bed, 
cleanliness, and a non -stimulating diet are important. 



594 A COMPENDIUM OF PRACTICAL MEDICINE. 

VARIOLA. 

Is an eruptive disease characterized by the presence of pus- 
tules which make their appearance at the end of the third 
exacerbation of the initial fever, when the temperature declines, 
but this apyrexia is followed by a secondary fever, or fever of 
maturation. It is known in common language as small-pox 
(Bartholow). 

Morbid Anatomy. — The characteristic lesion of small -pox is 
the eruption. The successive stages of the eruption are the 
macule, the papule, the vesicle and the pustule. The pustule 
undergoes desiccation. The macule is a reddish, slightly- elevated 
spot due to congestion of a circumscribed portion of the skin. 
A characteristic appearance of the small -pox vesicle is produced 
by a central depression in its roof, the so-called umbilication of 
the vesicle (Flint). 

Causes. — Small -pox is spread by a peculiar virus whose 
nature is unknown. In the open air the distance of contagion is 
about two and one-half feet. Rarely does an individual have a 
second attack. The period of incubation varies from live to 
thirty days, average fourteen days. The negro and Indian races 
are particularly susceptible to the disease (Bartholow, Flint and 
Loomis). 

Symptoms. — Stage of Invasion. — The disease is ushered in 
by a chill in the great majority of cases, and the chill is usually 
more marked than in the other eruptive fevers. Fever follows 
the chill. It is known as the primary fever. It is often intense, 
104° or 105° F. There are nausea, vomiting, coated tongue, pain 
in the stomach, also in the limbs andloins, headache and delirium. 
The duration of this stage, as a rule, is two days. The eruption 
begins to appear on the third or fourth day. 

Stage of Eruption. — The eruption, as a rule, appears first 
on the face, about the lips and chin, then on the neck and wrists; 
next on the chest and arms; then over the body. At first the 
eruption appears in the form of small red spots or specks. It is 
now a maculated eruption. The central part of the maculae be- 
comes hard, elevated and pointed. It is now a papular erup- 
tion. The papulae feel like small shot under the skin. Next a 



VARIOLOID. 595 

clear liquid becomes visible in the papulae, which now become 
vesiculce. On the fifth day of the stage of the eruption the vesi- 
cles are one-quarter to one-thircl of an inch in diameter. More 
or less of the vesicles present a depression in the centre. They 
are said to be umbilicated. This appearance is highly characteris- 
tic, indeed, almost pathognomonic. After this the vesicles be- 
come pustules. In other words suppuration takes place. On 
the appearance of the eruption the primary fever falls almost to 
the normal. This is a highly diagnostic feature of small-pox. 

Stage of Suppuration. — Usually on the sixth day after the 
first appearance of the eruption, there is a recurrence of the fever 
called suppurative or secondary fever. The face, hands and feet 
swell. The duration of this stage is four or five days. 

Stage of Desiccation. — This stage begins on about the 
twelfth day of the disease. The pus collects into a thick scab. 
During this stage the skin exhales a sickening characteristic 
odor. The whole duration of small-pox is between seventeen 
and twenty -four days (Flint and Loomis). 

Prognosis. — Varies— from ten to twenty-five per cent. die. 

Treatment. — -There is no special plan of treatment. The dis- 
ease will run its course and hence the expectant plan is to be 
pursued (Flint). 

VARIOLOID. 

Is modified small-pox. Small-pox is modified as a rule 
when produced by inoculation. Inoculation had been practiced 
from time immemorial in China and Persia. The eruption in 
cases of inoculated small-pox is usually slight. The pocks rarely 
exceed one hundred. Many of them abort. 

As a rule, variolation or inoculation affords complete pro- 
tection ever thereafter against small -pox. It was a great bless- 
ing prior to the discovery of vaccination. At the present day in 
most cases of varioloid the modification is due to vaccination. 

Vaccination does not always afford complete protection 
against small -pox, but in general the disease is materially modi- 
fied. 

The treatment of varioloid is the same as ordinary small-pox 
(Flint). 



596 A COMPENDIUM OF PRACTICAL MEDICINE. 

VACCINIA, OR COWPOX. 

Vaccinia and cowpox are names of a disease of the cow 
which, communicated to man, destroys in the great majority of 
cases for a certain period the susceptibility to small- pox. Cow- 
pox is transferred to man by the introduction of a virus. The 
operation for its communication is called vaccination. For the 
employment of vaccination as a means of preventing small- pox 
the world is indebted to the immortal Jenner, who published his 
discovery in 1798. The history of vaccinia in man is as follows: 
On the third day after vaccination red points or small papules 
are apparent where the vaccine virus was inserted. On the 
fourth day the papules are more developed. On the fifth day 
vesicles appear, and on the eighth day they are fully developed. 
On the ninth or tenth day the contents of the vesicles become 
purulent-, or pustules are formed. The pustules desiccate and 
fall off about the twenty -fifth day from the date of vaccination. 
Cowpox is not identical with small-pox, although allied to it. 
In a large majority of cases vaccination affords, for a time at 
least, absolute protection against small -pox. In a minority of 
cases the susceptibility to small -pox is not destroyed, but the 
disease is materially modified, constituting what is called vario- 
loid. Revaccinating every fixe years is to be advocated. The 
bovine virus should be used. The dangers following some cases 
of vaccination are abscesses, erysipelas, and blood-poisoning 
(Flint). 

VALVULAR DISEASES. 

Include those alterations in the structure of the valves them- 
selves or of the orfices which render the former incapable of per- 
forming their office in the closure of the latter. The lesions may 
be of two kinds — obstructive or regurgitant / that is, the orifice 
may be so narrowed as to obstruct the passage of the blood, or 
the valves may be so damaged as to permit the blood to regurgi- 
tate The narrowing of an orifice is termed stenosis; the incom- 
petence of a value to close the orifice is termed insufficiency. 
There are four points at which these lesions may occur, viz: 
mitral, aortic, tricuspid, and pulmonic orifices (Bartholow). 



VALVULAR DISEASES. 597 

Cardiac Murmurs. — A cardiac murmur is an abnormal sound 
produced within the heart or blood-vessels, either by obstruction 
to the blood- current, an abnormal direction of the blood- current, 
or a change in the blood constituents. Should any obstruction 
exist at either of the auriculo- ventricular orifices, the blood while 
passing through the opening at the end of a cardiac diastole, 
will impinge on such obstruction and cause a presystolic murmur. 

During a cardiac systole, if the semilunar valves obstruct 
the outgoing current, or if the mitral or tricuspid valves do not 
wholly close the auriculo ventricular orifices, then, in the one 
case, the blood -current as it passes over the obstruction at the 
semi -lunar orifices, will produce a systolic murmur, and in the 
other a systolic murmur will be produced by the backward 
current through the abnormal opening at the auriculo- ventricular 
orifices. If the pulmonary and aortic system have back of them 
a semilunar valve that does not completely close that end of the 
circuit, the blood will regurgitate into the ventricles during the 
period of cardiac rest, so that semilunar incompetence causes a 
diastolic murmur. 

The following is the order of relative frequency of cardiac 
murmurs: (1) Mitral regurgitation; (2) aortic obstruction; 
(3) aortic regurgitation; (4) mitral obstruction; (5) tricuspid 
regurgitation; (6) tricuspid obstruction; (7) pulmonary ob- 
struction; (8) pulmonary regurgitation. 

Of the eight cardiac murmurs, four are systolic, two dias- 
tolic and two presystolic. 

After determining whether the cardiac murmur be systolic, 
diastolic or presystolic, we next find the point of its maximum 
intensity. Murmurs arising at the mitral valve are loudest at 
the apex of the heart, or just above it; tricuspid murmurs are 
loudest over the lower part of the sternum; pulmonary murmurs, 
in the second left intercostal space close to the sternum, and 
aortic murmurs in the second right intercostal space at the edge 
of the sternum (Loomis). 

Rational Signs and Symptoms of Valvular Defects. — When 
stenosis exists at an orifice, the amount of blood passing through 
is necessarily lessened, with the effect to cause tschaemia and 
lowered tension in front, and stasis and abnormally liiu'h tension 



598 A COMPENDIUM OF PRACTICAL MEDICINE. 

behind. The same result follows if the contractions are feeble 
and the cavity dilated. Lesions of the aortic orifice, either ob- 
structive or regurgitant, lead to dilatation of the left ventricle, to 
diminished blood- supply, and lowered tension in the vessels of 
the aortic system, and to increased pressure and distention in the 
left auricle and pulmonary veins. Mitral lesions, either obstruc- 
tive or regurgitant, cause abnormal fullness and distention of the 
left auricle and pulmonary system, and ischsemia and lowered 
tension in the left ventricle and aortic system. Lesions of the 
tricuspid orifice induce dilatation of the right auricle and in- 
creased pressure in the venae cavge, and ischaemia and lowered 
pressure in the right ventricle and pulmonary artery. 

Lesions of the pulmonary orifice bring about dilatation of 
the right ventricle and elevated tension in the right auricle and 
venae cavae, and ischsemia and lowered tension in the pulmonary 
artery. All valvular lesions bring about, sooner or later, a state 
of the circulatory organs in which there are ischgemiaand lowered 
tension in the aortic system and stasis and high tension in the 
venous S} 7 stem. 

When compensation takes place this is not the case. Stenosis 
of an outlet is compensated by dilatation of the cavity and hyper- 
trophy of the walls. But the compensation may be easily over- 
come, and symptoms of valvular disease ensue. The most usual 
pulmonary disturbance induced by valvular disease is stasis of 
the blood, which leads to catarrh of the bronchi, and is accom- 
panied by cough, mucous expectoration, mucous and sub-mucous 
rales, etc. There is difficulty of breathing. There may be 
cyanosis with pain in the chest, shoulder, and down the arm. 
The condition of over-fullness of the venous is seen in the dis- 
tended state of the superficial veins (Bartholow). 

AORTIC OBSTRUCTION, OR STENOSIS, 

This is a common cardiac lesion, and is always accompanied 
by more or less hypertrophy of the left ventricle (Loomis). 

Causes. — Aortic stenosis is most frequently met in middle 
and advanced life; the mean age being forty-seven years. Inter- 
stitial endocarditis of rheumatic origin is its most frequent cause. 



VALVULAR DISEASES. 599 

Chorea and chronic Bright's disease may cause it. Atheroma or 
arteritis deformans extending to the valves somestimes gives rise 
to it. Men suiter from aortic stenosis oftener than women. 
Occupations that involve repeated, sudden and sever muscular 
effort induce it (Loomis). 

Symptoms. — The subjective symptoms of aortic stenosis are 
rarely well marked. When the compensation is overcome, 
then the pulmonary vessels and the venous system are abnorm- 
ally full. The scanty arterial supply causes pallor of the face, 
and syncope may occur from cerebral anaemia, but these are late 
symptoms. The pulse is normal in frequency, diminished in 
volume and fullness, and as a rule regular. Signs of arterial 
anaemia usually precede those of venous engorgement. There 
may be slight palpitation and paroxysmal pain in the chest. 
Aortic stenosis is more often associated with cerebral embolism 
than any other valular lesion. The left middle cerebral artery is 
the most common seat of cardiac emboli (Loomis). 

Physical Signs. — Inspection shows the area of cardiac im- 
pulse to be abnormally increased. 

Palpation. — The impulse is felt to be forcible, and may be 
accompanied by a heaving or lifting sensation. The apex is dis- 
placed to the left and slightly downward. 

Percussion. — The area of cardiac dullness increases. 

Auscultation. — Aortic obstructive murmurs are loudest and 
most distinct at the second right intercostal space and at the 
sternal insertion of the third left costal cartilage. They are sys- 
tolic and accompany the first sound of the heart. These 
murmurs are always harsh, and heard most distinctly at the 
commencement of the systole. The area of diffusion of this 
murmur follows the law that a murmur is propagated in the 
direction of the blood- current. It is conveyed along the aorta 
into the carotids and one of its characteristics is that it is heard 
in the great vessels of the neck. It may be heard in the abdom- 
inal and thoracic aorta (Loomis). 

Differential Diagnosis. — Aortic obstruction may be mistaken 
for mitral and tricuspid regurgitation, an ancemic bruit, or the 
murmur of a thoracic aneurism. Both mitral and tricuspid 
regurgitation and aortic stenosis produce 4 a systolic murmur. The 



600 A COMPENDIUM OF PRACTICAL MEDICINE. 

murmur of aortic stenosis is heard with its maximum intensity at 
the third left sterno- costal articulation, and diminishes in inten- 
sity toward the apex of the heart. The murmur of mitral regur- 
gitation is heard loudest at the apex -beat. The murmur of aortic 
stenosis is conveyed into the vessels of the neck; that of mitral 
regurgitation to the left, in the direction of the apex -beat, and is 
heard behind, between the fifth and eighth dorsal vertebras, at 
the left of the spine, with very nearly the same intensity as at the 
apex. Thejmfodin aortic stenosis is normal in frequency, di- 
minished in volume and fulness, and, as a rule, regular in rhythm; 
while in mitral regurgitation it is irregular in rhythm and force, 
and is easily increased in frequency. Gastric, intestinal, renal, 
hepatic, and bronchial symptoms are present in mitral regurgita- 
tion, wmile the subjective symptoms of aortic obstruction are 
cerebral in character. The murmur of aortic stenosis is harsh, 
that of mitral regurgitation soft, and often musical. 

Tricuspid regurgitation is accompanied by a systolic mur- 
mur which is rarely heard above the third rib ; while that of 
aortic stenosis has its point of maximum intensity at the second 
right intercostal space and at the sternal insertion of the third 
left costal cartilage. Tricuspid regurgitation is accompanied by 
jugular pulsation / while the murmur of aortic obstruction is 
heard in the arteries of the neck. The pulse in tricuspid disease 
is normal; in aortic stenosis it is diminished in volume and ful- 
ness and is sometimes hard and wiry. 

Anosmia produces a murmur heard loudest in the carotids 
and accompanied by a venous hum. In anaemia there are three 
murmurs: cardiac, venous, and arterial. The murmur is soft 
and blowing in anaemia, and harsh in aortic obstruction. 

In thoracic aneurism the dilating impulse on palpation, the 
normal force of the heart-beat, the single and double bruit, and 
the pain are all important signs, which are absent in aortic sten- 
osis (Loomis). 



VALVULAR DISEASES. 601 

AORTIC INSUFFICIENCY, OR REGURGITATION, 

This is an abnormal condition of the aortic valves, which 
prevents their complete closure, and allows a backward current 
of blood to now from the aorta into the left ventricle during its 
diastole (Loomis). 

Causes. — Rheumatic endocarditis is the chief cause; but it 
may follow sudden and violent muscular effort, atheroma of the 
aorta, or endarteritis. Dilatation of the aorta at its origin may 
induce it. Alcoholismus and gout predispose to it. Fagge says 
only fifty per cent, of the cases give a rheumatic history 
(Loomis). 

Symptoms. — So long as hypertrophy compensates for the re- 
gurgitation, there is little or no inconvenience experienced by 
the patient. In time the hypertrophy induces excessive heart - 
action during excitement or violent muscular effort. The heart- 
action then becomes labored, and the patient is anxious, nervous 
and fretful, and knows well that exercise will increase his un- 
comfortable symptoms. The respirations are accelerated with 
the cardiac palpitation; as the disease advances, attacks of head- 
ache and vertigo become more and more prolonged and severe; 
the patient complains of muscce volitantes, dyspnoea, and giddi- 
ness, and is compelled to sleep with his head elevated. Palpita- 
tion and a visible carotid impulse are now constantly present. A 
frequent symptom is a distinctly paroxysmal shooting or stab- 
bing pain over the heart, in the left shoulder, or extending down 
the left arm. The pain may pass from the middle of the sternum 
down the right arm. The pain may be accompanied by numb- 
ness. When mitral insufficiency exists with the aortic, the sys- 
temic veins become overloaded and cyanosis and dropsy result; 
the dropsy appears first as oedema of the feet, and gradually ex- 
tends upward until there is general anasarca. 

Later in the disease, there is orthopnoea, sudden startings in 
sleep, angina pectoris, and there may be albuminuria and en- 
largement and tenderness of the liver. Attacks of syncope occur. 
These patients may die at any moment. The pulse is visible in 
the vessels of the head, neck and upper extremities. It is often 
called the "piston pulse" tk Corrigarts pulse" ">r<it< \r-ha mmer^ 



602 A COMPENDIUM OF PRACTICAL MEDICINE. 

"jerking" "splashing " or "collapsing" pulse. It is large and 
distinct. When the arm is raised above the head, its character - 
istics are more apparent. The radial impulse is felt a little after 
the apex -beat (Loomis). 

Physical Signs, — Inspection shows an increase in the area 
and force of the apex -beat. When compensation ceases to 
balance the forces in the heart, the apex-beat becomes feeble and 
diffused. 

Palpation gives a heaving, lifting impulse which is trans- 
mitted over a large area. The apex-beat is displaced down and 
toward the left, sometimes as far as the eighth rib, and two and 
one-half inches to the left of the left nipple. 

Percussion gives increased area of dullness. 

Auscultation. — Aortic regurgitation is attended by a dias- 
tolic murmur, which may take the place of, or immediately 
follow, the second sound of the heart. This murmur has its 
maximum intensity at the sternal end of the second right inter- 
costal space, or at the sternal junction of the third rib on the 
left side. Its area of diffusion is greater than any other cardiac 
murmur. It may be heard in the carotids and at the sides of the 
chest. It is a soft, blowing murmur, sometimes rough and fre- 
quently musical (Loomis). 

Differential Diagnosis. — Aortic regurgitation may be mistaken 
for aortic stenosis, mitral obstruction, aneurism of the aorta, and 
pulmonic insufficiency. Aortic stenosis gives a systolic murmur, 
while aortic regurgitation produces a diastolic murmur. Mitral 
obstruction gives a presystolic murmur, while aortic reflux a 
diastolic murmur. Mitral stenosis is accompanied by no hyper- 
trophy or dilatation of the left ventricle; whereas, these condi- 
tions are always present in aortic reflux. The murmur of mitral 
stenosis is the longest of all cardiac murmurs, and is never 
heard behind; whereas, that of aortic regurgitation is heard at 
the sides of the chest and along the spinal column. In aneurism 
there is absence of left ventricular dilatation and hypertrophy, 
and presence of a peculiar jerking pulse. Pulmonic insufficiency 
is the rarest of all valvular lesions. 



MITEAL OBSTRUCTION, OR STEXOSIS. 603 

MITRAL OBSTRUCTION, OR STENOSIS. 

Stenosis of the mitral orifice probably never occurs without 
some insufficiency. 

Causes. — Mitral stenosis is most frequent in the young; it 
rarely occurs after fifty. It is twice as frequent in females as in 
males. It is frequently of congenital origin. Acute rheumatic 
endocarditis is its most frequent cause (Loomis). 

Symptoms. — The subjective symptoms of mitral stenosis are 
few. Usually after violent exercise there is more or less cardiac 
palpitation, and this will cease as soon as the auricle can empty 
itself, which is accomplished by the patient assuming a recum- 
bent position on the right side, with the head slightly elevated. 
This class of patients are usually pale and anaemic, and frequently 
experience a sharp pain in the region of the apex -beat. The 
pulse is regular and normal in character, so long as the auricular 
hypertrophy compensates for the auricular dilatation. The 
passive pulmonary hyperemia which attends the advanced stages 
of this form of cardiac disease causes habitual dyspnoea, which is 
exaggerated by physical exertion and by a dry, hacking, 
"teasing" cough, which resembles the so-called nervous cough. 
After severe exercise, a pint of glairy, watery mucus may be ex- 
pectorated. The mucus may be blood-stained, indicative of 
pulmonary congestion and oedema. Haemoptysis is not infre- 
quent, and small quantities of pure, fiorid blood may be expecto- 
rated. Orthopnoea is a rare symptom (Loomis). 

Physical Signs, — Inspection.— A.* the left ventricle does not 
receive its normal quantity of blood, the cardiac impulse is 
feeble. 

Palpation. — On palpation, the apex- beat is less forcible 
than normal, and a distinct purring thrill will be communicated 
to the hand. This thrill is a constant attendant of mitral 
stenosis. 

Percussion. — The increased size of the left auricle may 
cause an increase in the area of cardiac dulness, upward and to 
the left, at the second left intercostal space. 

Auscultation. — Mitral stenosis is characterized by a loud 
"churning,'' 1 "grinding," or blubbering" presystolic murmur. 



604 A COMPENDIUM OF PRACTICAL MEDICINE. 

This murmur is of louger duration than any other cardiac mur- 
mur. The murmur is heard with its maximum intensity a little 
above the apex-beat. It is louder when the patient is erect than 
when in a recumbent posture. When mitral reflux and mitral 
obstruction coexist, the two murmurs run into each other, con- 
stituting a single murmur. A mitral obstructive murmur is never 
soft or musical (Loomis). 

Differential Diagnosis. — The diagnosis of mitral stenosis de- 
pends upon the existence of two physical signs, the " purring 
thrill" and aloud, long, blabbering presystolic murmur. 

MITRAL INSUFFICIENCY, OR REGURGITATION. 

Regurgitation at the mitral orifice is due to a condition of 
the mitral valves which allows the blood to flow back from the 
left ventricle into the left auricle (Loomis) - 

Causes. — Mitral regurgitation may occur at any age; but it 
is especially liable in the young to follow rheumatic endocarditis, 
which causes extensive thickening, induration and shortening of 
the mitral valves. It may be secondary to aortic lesions. Ex- 
cessive dilatation of the left ventricle may cause it. Diseases of 
the columnar carnese and chordae tendineae will also cause mitral 
insufficiency. Ulcerative endocarditis may also cause it, either 
by perforation and rupture of the valves, or by rupture of the 
chordae tendineae (Loomis). 

Symptoms. — During the early stage, when the hypertrophy 
of the right ventricle compensates for the regurgitation, there are 
no rational symptoms; but when the right ventricle is unable to 
overcome the obstruction to the pulmonary circulation caused by 
regurgitant blood current, there will be more or less dyspnoea, 
and a short, hacking cough with an abundant expectoration of 
frothy serum. Sometimes the serum is blood-stained. In ad- 
vanced cases, the extremities, face and lips become blue, the 
result of the interference with the capillary return circulation. 
The liver becomes enlarged and hardened. There will be ano- 
rexia, nausea and a sense of oppression in the epigastrium. 
Sometimes the hepatic circulation becomes so obstructed as to 
interfere with bile secretion, and thus give the skin a greenish 



REGURGITATION. 605 

tint. There are frequent attacks of gastric and intestinal 
catarrh. Headache, dizziness, vertigo and stupor result from the 
passive cerebral hyperemia. The urine is diminished in quan- 
tity, high-colored, and loaded with lithates; it sometimes con- 
tains albumeu. There may be free haemoptysis. Another late 
symptom of mitral regurgitation is dropsy / it first appears in 
the lower extremities, and gradually extends over the whole 
body. The pulse of mitral regurgitation is, at first, regular in 
force and rhythm; later it becomes diminished in volume, irreg- 
ular and diminished in force (Loomis and Bartholow). 

Physical Signs. — Inspection. — The area of the visible cardiac 
impulse is increased. The epigastric pulsation is due to right 
ventricular hypertrophy, which is a condition always found with 
extensive mitral regurgitation. The jugular veins appear swol- 
len, especially when the patient is lying down. Palpation. — 
The apex-beat is displaced to the left and is felt lower than 
normal, Palpation sometimes reveals a systolic thrill, which is 
confined to the region of the second left intercostal space near 
the sternum. Percussion. — The area of dullness is increased. 
Auscultation. — Mitral insufficiency is attended by a systolic 
murmur. It is usually soft and blowing, but may be musical. 
This murmur takes the place of the first sound of the heart, and 
is heard with its maximum intensity at the apex -beat. A loud 
systolic murmur at the apex, and not heard at the back, is not 
indicative of mitral reflux (Loomis). 

Differential Diagnosis. — Mitral regurgitation may be mistaken 
for aortic ohstruction and tricuspid regurgitation. The diagnosis 
between mitral reflux and aortic stenosis has already been con- 
sidered. Both mitral and tricuspid insufficiency produce a sys- 
tolic murmur; a mitral regurgitant murmur has its maximum 
intensity at the apex, while the maximum intensity of a tricuspid 
regurgitant murmur is to the left of the base of the erisiform 
cartilage. Pulmonary symptoms are prominent in mitral reflux 
and absent in tricuspid regurgitation (Loomis). 



606 A COMPENDIUM OF PRACTICAL MEDICINE. 

TRICUSPID OBSTRUCTION, OR STENOSIS. 

This lesion is so rare that there are no rules for its diagnosis. 
But its symptoms would be general cyanosis, swollen jugulars, 
dilated right auricle, headache, dizziness, vertigo, etc. 

TRICUSPID INSUFFICIENCY, OR REGURGITATION. 

This lesion is usually secondary to mitral disease. 

Causes. — The most frequent cause of tricuspid regurgitation 
is mitral stenosis and regurgitation; next chronic bronchitis, and 
pulmonary emphysema (Loomis). 

Symptoms. — There may be cardiac palpitation, dyspnoea, 
irregular heart action, enlarged liver, dingy skin, obstinate con- 
stipation and hemorrhoids. Venous stasis in the stomach is 
evinced by dyspepsia, nausea, vomiting and hsematemesis. Pas- 
sive cerebral hyperemia is marked by headache, dizziness, vertigo, 
and muscse volitantes. Placing the patient in a horizontal posi- 
tion, after the disease has existed for some time, causes the face 
to become turgid and blue. Jugular and epigastric pulsation 
are its characteristic physical signs. A very late symptom is 
dropsy (Loomis). 

Physical Signs. — Inspection. — In extensive tricuspid disease, 
the area of cardiac impulse is increased more than in any other 
valvular lesion. This area sometimes extends from the nipple 
to the ensiform cartilage. There is a visible impulse in the 
jugulars. 

Palpation. — The apex-beat is indistinct. Pulsation occurs 
in the epigastrium. 

Percussion. — Shows an increase in the area of cardiac dull- 
ness. 

Auscultation. — The murmur is soft, faint and blowing, and 
is heard with greatest intensity over the lower part of the ster- 
num. It is heard with the first sound of the heart (Loomis). 

Pulmonic Obstruction and Regurgitation are so rare, clinic- 
ally, that they may be disregarded (Loomis). Prognosis in 
valvular disease. — The prognosis varies. In aortic stenosis life 
may be prolonged many years. Aortic regurgitation is a graver 
form of disease than aortic stenosis. Mitral stenosis admits of 



WAKTS. 607 

no compensation. It is usually grave. Mitral regurgitation is 
not serious if compensated (Loomis). 

Treatment of Valvular Diseases. — The treatment can be 
summed up in rest, diet and regimen. Rest must be mental as 
well as physical. Straining is to be avoided. The appetite, 
emotions and passions must be under perfect control, hence a 
sedentary country life is best. The bowels should be daily 
gently moved. The body must be warmly clothed. Prolonged 
exposure to cold is to be avoided. Warm baths are beneficial. 
When the heart power is feeble, tincture of digitalis and tinc- 
ture of perchloride of iron are to be given in ten- drop doses, 
three times a day. In some cases arsenic acts well. The use of 
alcohol, strong tea or coffee, or tobacco, is to be prohibited, 
small doses of quinine and strychnine are useful. The dropsy 
may be relieved by pulvis jalapce convp., combined with calomel, 
squills, juniper, broom and cream of tartar, act as diuretics. For 
the precordial pain, a belladonna plaster and morphine will give 
relief. Strophanthus will be found valuable in some cases. 
Nitro- glycerine may be employed to lower arterial tension, and 
thus relieve a laboring heart. Caffeine and spartein sometimes 
give relief (Loomis). 

WARTS. 

Are outgrowths of the papillae of the skin. They are com- 
mon on the hands and other parts of the body of the young, and 
more rare in the adult. When on the exposed parts of the body, 
they assume a horny hardness. Warts are fiat or pedunculated. 
They occur on the neck, orifice of the nose, mouth, eyes, ears, 
and anus, also on the prepuce and labia. The fiat warts occas- 
ionally come and go in a way which cannot be accounted for. 
An epithelial cancer may appear in a wart. Venereal mart*, so- 
called, are very abundant, whether they grow from the glans 
penis or prepuce of the male or labia of the female. They are 
pedunculated, moist, and highly vascular, and are clearly con- 
tagious. Warts, however, may occur at times in these parts 
without any venereal contact (Bryant). 

Treatment. — Pare away the cuticle and then touch the sur- 
face with a glass rod moistened with strong acetic acid, carbolic 



608 A COMPENDIUM OF PRACTICAL MEDICINE. 

acid, acid nitrate of mercury, or potassa fusa, care being taken 
to protect the skin around the wart. Pedunculated dry warts 
should be cut off with the knife or scissors. The application of 
some powder as oxide of zine, or even starch may cause them to 
dry up, and disappear (Bryant). 

YELLOW FEVER, 

Is an endemic miasmatic contagious disease, which usually 
appears as an epidemic. It prevails most in tropical regions, 
occurring only south of 48° north latitude, and is characterized 
by a yellowish discoloration of the skin. It has been called 
black-vomit (Loomis). 

Morbid Anatomy. — The liver is usually slightly enlarged. 
Its color is yellow, like butter, cheese, mustard, or chamois. 
The blood is of a darker color than normal, and coagulates 
slowly. The mucous membrane of the stomach and intestines is 
the seat of hemorrhagic erosion, which causes the black- vomit. 
Changes take place in the heart, lungs, kidneys, etc. (Loomis 
and Flint). 

Causes. — Nothing is as yet known of the nature, form and 
composition of the morbific principle, or specific microbe of 
yellow fever. It is indigenous in warm climates. Yellow fever 
is rarely developed south of 20° south or north of 40° north 
latitude. The miasm is more active at night than in the day- 
time. The natives of yellow-fever localities are rarely attacked. 
The disease is rarely experienced a second time in the same indi- 
vidual. The negro race seems to be singularly exempt from a 
liability to this disease. All ages suffer. The special cause is 
destroyed by cold. It is a matter of common observation that 
an epidemic is arrested by one or two hard frosts. Commercial 
seaports are pre-eminently the starting-points of great epidemics. 
Crowding is one of the essentials to its development. The 
period of incubation varies in duration from twelve hours to 
fifteen days (Flint and Loomis). 

Symptoms. — An attack of yellow fever usually is abrupt. It 
is denoted generally by a chill, with or without rigor. Fever 
follows, varying between 102° and 110° F. The pulse seldom 



YELLOW FEVER. 609 

exceeds 100. The tongue is coated. Vomiting may occur early 
but is usually a later symptom. The bowels as a rule, are con- 
stipated. Cephalalgia is sometimes intense. Pain in the loins 
and calves of the legs is sometimes a prominent symptom. The 
eyes are reddened, irritable, watery, or tearful. The fever con- 
tinues for a period varying between a few hours and three days. 
Then follows either a marked abatement or entire cessation of 
fever. The condition following the febrile paroxysm has been 
called "the state of calm. ,< ' This is called the second stage of 
the disease. In a large proportion of fatal cases and 
in a few of the cases ending in recovery the black vomit 
occurs. This, taken in connection with other symp- 
toms, is pathognomonic of the disease. The black vomit rarely 
occurs until after the febrile paroxysm, and usually ceases twelve 
to twenty-four hours before death. During the second stage the 
evacuations from the bowels resemble sometimes tar or molasses. 
Yellowness of the surface of the body occurs after the febrile 
paroxysm. Hemorrhage from the stomach, intestines, kidneys, 
bladder, nostrils, gums, uterus, etc., is often a striking feature. 
Patients sometimes do not take to the bed, but keep about their 
usual avocations, not thinking themselves much ill, often a few 
hours before death. The face is flushed, the eyes injected, bril- 
liant, transparent, fiery and glassy. The countenance is that of 
suffering, dejection, anxiety, anguish, despair, terror, stupidity. 
vacancy, astonishment, etc. The duration of the disease after 
the febrile paroxysm varies between twelve hours and three or 
four days. The third stage is called the stage of collapse or 
exhaustion in fatal cases. If death do not take place, the third 
stage is the stage of convalescence. The duration of the disease 
varies between three and nine days. The average duration is 
less than a week (Flint and Loomis). 

Treatment. — There is no specific remedy for yellow fever. 
Patients should take to the bed at once. Free ventilation, clean- 
liness and cold sponging are useful. Mercury lias been tried. 
Ice may be swallowed. The acetate of lead with opium has been 
much extolled to prevent black vomit. Milk with lime- water is 
probably the best article of diet. Great restlessness calls for 
opium. Alcoholic stimulants may be given (Flint and Loomis). 



CHAPTER III. 

MEDICAL DISEASES OF WOMEN 



BY W. J. GILLETTE, M. D, 



AMENORRHEA. 

The term amenorrlioea signifies either an entire absence, a 
less than normal amount, or an habitual delay of the return of 
the menstrual discharge. To those cases in which menstruation 
has never become established, the term primary amenorrhcea is 
applied, and secondary amenorrhcea to those in which menstrua- 
tion has been once established but has either completely or in 
great measure disappeared. 

For the proper establishment of menstruation it is necessary 
that the sexual organs be properly developed and that there be 
sufficient nutrition and vigor of the general system to sustain it. 
The primary form of amenorrhcea is usually due to a lack of de- 
velopment of the uterus and ovaries which remain in an infantile 
condition. It is also possible that there may be an entire ab- 
sence of the ovaries and uterus. The causes that operate to pro- 
duce secondary amenorrhcea will also act to produce the primary 
form. Secondary amenorrhcea is occasioned by any constitu- 
tional derangement of the system which tends to greatly lower 
the vitality, as chlorosis, Bright's disease, malaria, diabetes, can- 
cer, tuberculosis, and any of the acute fevers as well as syphilis. 
The influence of the nervous system is also a great factor in the 
production of secondary amenorrhcea, how else can we account 
for the frequently observed temporary suppressions of menstrua- 
tion, as a result of fright, in the insane, in prisoners, in women 
taking sea voyages and often in the unmarried who live irregular 



AMENORRHEA. 611 

lives and have subjected themselves to the danger of pregnancy. 
Obesity and plethora are often observed coincidentally with 
amenorrheea possibly, standing in a . causative relation. In the 
consideration of any case of secondary amenorrheea, the possi- 
bility of pregnancy being the cause of the suppression should 
never be lost sight of. Any of the inflammatory diseases of the 
uterus and adnexa, either chronic or acute, together with super - 
involution or long standing sub -involution, mutilations of the 
uterus and ovaries and even the too vigorous use of the curette 
and the cautery have been followed by amenorrheea. Menstrua- 
tion always disappears after the complete removal of the uterus 
and in a large majority of cases after the ovaries and tubes have 
been removed; occasionally, however, it happens that menstrua- 
tion continues after complete removal of the ovaries, usually ceas- 
ing; after a vear or two. 

Tumors of the ovary do not usually interfere with men- 
struation, at least not until a very late date, or unless both 
ovaries are involved, and finally become destroyed completely 
by the growths, when menstruation may cease. An imperforate 
hymen, cervix or vagina may prevent the appearance of the 
menstrual flow, but these cases can easily be diagnosed from 
amenorrheea due to lack of development of the uterus and 
ovaries, by the fact that the patient has the usual monthly re- 
curring symptoms of menstruation, pain, discomfort, etc., and on 
examination a well marked bulging may be discovered at the 
vulva and sometimes a tumor extending above the pubis. Most 
of these cases are due to imperforate Irymen and are easily cured 
by incising the hymen under antiseptic precautions and allowing 
the retained menstrual blood to escape, after which the regular 
monthly period becomes established. The sudden discharge of 
a retained menstruation is not entirely free from danger, and it 
is best to allow it to come away slowly, afterwards washing with 
an antiseptic fluid, as a solution of bichloride of mercury (1 to 
5000). 

The diagnosis as to whether a case of primary amenorrheea 
is congenital or not, is of importance. If it be congenital, an 
examination reveals the absence or abnormality of the interna] 
sexual organs. Externally the genitals may he normally formed, 



612 A COMPENDIUM OF PRACTICAL MEDICINE. 

the pubes covered with hair and the mammae well developed* 
This class of cases may develop masculine characteristics, the 
upper lip covered with hair, and the muscular and mental char- 
acteristics more nearly approaching the male than the female; 
but often there is nothing in the general appearance to indicate 
anything sexually wrong. In the second class of cases the pubes 
remain bare, the mammae undeveloped and there seems to be a 
complete absence of sexual development, with always a general 
appearance of masculinity. These do not develop symptoms of 
any kind indicating the trouble. Nothing can be done to relieve 
the condition when distinctly congenital. Cases not congenital 
but of delayed development may, if treated while the patient is 
yet young, be benefited by removing the cause of the delay, 
which will usually be found to be general debility with improp- 
er mode of living. Remedies directed to bettering the consti- 
tutional conditions, with sometimes local stimulation of the 
uterus by the use of electricity, the dilating from time to time of 
the cervix, etc., will be found of value. Internal remedies, such 
as the bitter tonics, gentian, columbo, etc., with iron, nux vomica 
and cod-liver oil, are very useful. 

Secondary amenorrhoea may be occasioned by a variety of 
pathological conditions, as indicated above, and the treatment of 
it will vary, according to the cause. When due to any of the 
debilitating diseases, these diseases should be treated, and little 
attention paid to the menstruation. As soon as health is re-es- 
tablished, menstruation, as a rule, will recur. The amenorrhea 
of chlorosis is best treated by giving iron and arsenic with saline 
purgatives, or by giving arsenic for a time, followed by iron and 
.aloes pills. I have found Blaud's pill a most useful one in these 
cases. Manganese has been recommended, but its value is ques- 
tionable, and if it is of value, it is certainly not the equal of 
iron. Potassium permanganate, tansy, savine or saffron have 
been recommended, but they are not entirely free from danger, 
and should seldom, if ever, be given. 

The prognosis is serious or not, depending entirely on the 
pathological condition causing the amenorrhea. In young girls 
it is usually more favorable than in women who have borne 
children. 



DYSMENORRHEA. 6 1 3 

Sudden suppression of the now during a monthly period is most 
frequently caused by a disturbance of the circulation, by expos- 
ure to cold, by excessive exertion, or by great mental emotion, 
and this sudden stoppage may be followed by inflammation of the 
ovaries, uterus and tubes, if the flow is not promptly re-established. 
The treatment at first should be directed to the re- establishment 
of the circulation through its proper channels. Warm sitz-baths 
and hot drinks should be given, the patient placed in bed, with 
hot fomentations over the abdomen. A cathartic may be given 
with advantage. If the menstruation fails to be re-established, 
as soon as the period has passed means should be adopted for 
the relief of the uterine congestion, as hot douches, warm sitz- 
baths, the application of leeches to the cervix, or scarifying. 
Exercise should be restricted. 

DYSMENORRHEA. 

Dysmenorrhcea, or painful menstruation, is due to patho- 
logical conditions which may be grouped roughly under four 
heads : 

1. Defective nerve supply, or the neuralgic. 

2. Info minatory. 

3. Mechanical obstruction to the flow. 

4. The membranous variety ,in which the mucous membrane 
of the uterus, instead of undergoing fatty degeneration, is cast 
off entire or in shreds. 

The neuralgic variety seems to be due entirely to a general 
neurasthenic condition, the uterus and adnexa presenting no dis- 
coverable pathological lesions that could account for the severe 
pain. This class of patients is usually hysterical and suffer from 
nervous troubles. The digestion is bad and they are usually 
anaemic. Hyperesthesia over the lower abdomen will usually be 
observed even during the inter -menstrual period. 

The diagnosis must be based upon the fact that no lesion of 
the uterus can be found and upon the general condition of neu- 
rasthenia. Often this trouble is associated with rheumatism. 
Prognosis is not very favorable but in time with careful treat- 
ment the trouble may disappear. The indications for treatment 



614 A COMPENDIUM OF PRACTICAL MEDICINE. 

are general rather than local. If the patient suffer from rheu- 
matism, tincture of guaiac, colchicum, or salicylate of sodium will 
be found of benefit. Tonics, out- door exercise, and a good 
nourishing diet with cod-liver oil, will aid greatly. In the purely 
anaemic and neurasthenic cases, very often the continued use of 
chlorate of potash, iron, and the bitter tonics will be found of 
value. For the actual suffering some of the coal tar derivatives, 
as antipyrin and phenacetin, or pulsatilla given every hoar will 
greatly relieve. Opium and alcohol, although they promptly re- 
lieve, should not be given for the habit of their continued use 
may be acquired. 

Inflammatory dysmenorrhea is a result 'of inflammation of 
the uter as and adnexa. Whenever the uterus becomes inflamed 
it is seldom that this inflammation does not extend to the ovaries 
and tubes, sometimes producing chronic pelvic peritonitis with 
accumulations of pus. Whenever the inflammation is largely 
limited to the uterus the pain begins with the flow, and contin- 
ues while it lasts; but if the inflammation has attacked the tubes 
and ovaries the pain will begin three or four or more days before 
the flow starts and is usually then in a large measure relieved. 
The pain of menstruation due to inflamed ovaries and tubes is 
usually most marked on the left side, radiating down the thigh 
and much increased when the patient walks about. These cases 
have usually a history of sterility and though much may be done 
for them in the way of palliative treatment, yet a complete cure 
aside from the removal of the ovaries and tubes, is usually not to 
be looked for. Headache, nervousness, and some fever usually 
accompany the pain, and the patient is sometimes much nau- 
seated. 

The diagnosis will be indicated by the character of the pain 
and the evidences of inflammation within the pelvis. 

The treatment will be that indicated for inflammation of the 
pelvic organs. The bowels should be kept open with salines 
and the patient kept in bed during the menstrual period, Hot 
fomentations may be applied to the lower part of the abdomen. 
To control the pain, some one of the coal-tar derivatives may be 
given, as antipyrin, phenacetin, etc. Opium and alcohol should 
be withheld. During the intermenstrual period, treatment for 



DYSMENOEEHCEA. 615 

the pelvic inflammation should be persistently followed, as hot 
douches, painting the roof of the pelvis with iodine, using 
tampons of boro-glyceride, etc. Ichthyol is a most valuable 
remedy in these cases used as a suppository,- or a dressing within 
the vagina. 

Any condition which interferes with the free discharge of 
the flow produces what is known as mechanical dysmenorrhcea. 
These obstructions are various, and include stenosis of the cervix 
at either the internal or external os, acute flexions, or pressure of 
tumors as fibroids or polypi that have found lodgment in the 
cervical canal. Under this head may be classed cases of imper- 
fect development of the uterus, and usually with anteflexion. 
The pain of obstructive dysmenorrhcea is spasmodic in character, 
blood accumulates behind the obstruction, and the contractions 
of the uterus to force it by the obstruction, occasion it. As soon 
as the blood is discharged the contractions cease, the patient is 
relieved and so remains until the accumulated blood is ao^ain 
forced off. The paroxysmal character of the pain will assist in 
making a diagnosis. 

Prognosis may be good or bad, depending entirely upon our 
ability to relieve the obstruction. Medicines will be of but little 
avail; this class of cases of. necessity can only be assisted by the 
surgeon. If the stenosis be at either os, a thorough dilation of 
the canal may cure. Dilation and curettment may also be em- 
ployed when the uterus is flexed. Flexions of the uterus are 
nearly always accompanied by congestion of the mucous mem- 
brane. Removal of growths, if such exist, must be done. 

Membranous di/smenorrlicea is that form in which after a 
time the paroxysm of pain is followed by expulsion of a mem- 
brane from the uterus. These membranes show a smooth reddish 
inner surface upon which the orifices of the utricular glands may 
be seen by the naked eye and an external rough, uneven surface 
which appears as though torn from its connections, and at times 
contains small blood clots. In many cases the membrane is a 
complete sac containing three openings corresponding to the os 
uteri and orifices of the tubes. 

The symptoms of membranous dysmenorrhcea are not differ- 
ent from those of other forms of dysmenorrhcea. The pain, how- 



616 A COMPENDIUM OF PRACTICAL MEDICINE 

ever, is extremely severe, paparoxvsmal in choracter, usually the 
most severe just before the membrane is expelled. In nervous 
patients, hysterical conditions are not uncommon. The flow may 
be scanty in fact usually is. The membrane is cast off from the 
second to the fifth day. Occasionally the membrane is cast off 
without pain. Patients with membranous dysmenorrhea are 
usually sterile, but if pregnancy should supervene, they may 
afterwards menstruate normally, though cases are reported where 
pregnancy did not effect a cure. Prognosis is not very favor- 
able. 

Treatment. — Many remedies have been employed for this 
trouble and sometimes with benefit. The most popular method 
is thoroughly dilating and curretting the uterus. Cauterization 
of the uterine canal with nitrate of silver, tincture of iodine, or 
carbolic acid may be tried. The introduction of suppositories 
containing iodoform has been recommended by Skene. Dilating 
the uterus, curretting and cauterzing the endometrium with the 
Paquelin cautery, followed by packing the uterus with iodoform 
gauze has met with success. For the immediate relief of pain 
the same remedies as are employed in the other forms of dys - 
menorrhcea should be employed. A resort to opium is only to 
be thought of when all other remedies have failed to relieve. 

LEUCORRHCEA. 

By the term leucorrhoea is commonly meant any discharge 
other than blood coming from the genitals, though literally the 
term means a white discharge. These discharges from the vagina 
are popularly called the "whites." They may come from any 
point along the genital mucous membrane, from the vulva, the 
vagina, the cervix, or the body of the womb, and are caused by 
many different pathological conditions, but there are, however, 
forms of leucorrhoea which may be regarded as physiological, 
such as the large quantities of mucus poured out often during 
pregnancy. The abundant discharge of mucus preceding and 
following menstruation cannot be considered pathological. Also 
in girls suffering from amenorrhcea there is in many instances 
from time to time profuse discharge of mucus which takes the 



LEUCORRHCEA. 617 

place of proper menstruation and has been called " menstrual 
leucorrhcea ." These forms of leucorrhcea require no treatment. 
A very considerable number of cases of leucorrhcea may be re- 
garded as catarrh of some portion, or all, of the genital mucous 
membrane, very much of the same character, as catarrh of other 
mucous membranes, as of the respiratory tracts or the alimentary 
canal. In the respiratory tract we have bronchitis, laryngitis 
and nasal catarrh; in the alimentary canal, diarrhoea. 

What is true of these membranes is also true of the vaginal 
and uterine, they alike are influenced by climatic changes and a 
severe leucorrhcea may be lighted up by exposure to cold, check- 
ing suddenly the secretions of the skin, or while attending to 
calls of nature, draughts of air blowing over the exposed mucous 
membrane of a patulous vagina may give rise to it. Leucorrhcea 
is not uncommon in women suffering from tuberculosis, or any 
strumous diathesis, and often in these cases the mucous mem- 
brane presents no discoverable anatomical lesion. Sometimes, 
however, the mucous membrane is attacked by tubercle, and then 
severe lesions present. Hereditary or acquired syphilis will 
produce leucorrhcea of a very intractable form and it often coex- 
ists with gout and rheumatism. Whenever the tissues are badly 
nourished and the patient is greatly debilitated, mucus discharge 
from the vagina is easily induced. All of the foregoing influ- 
ences will, it is true, induce leucorrhcea, but by far the most im- 
portant and most frequent cause of the discharge is some uterine 
disorder marked by lesion of structure as the inflammatory dis- 
eases of the vagina and uterus, such as specific (gonorrhoea) and 
non-specific, tumors (malignant and non-malignant), displace- 
ments and lesions of structure, such as those following confine- 
ments. Hence, leucorrhcea should be considered, especially if 
constant, as extremely significant of uterine disease. If intermit- 
tent entirely disa}3pearing from time to time, it is not so likely 
to be an indication of uterine disease. 

The occurrence of leucorrhcea in children is deserving of 
especial attention. It sometimes follows the acute exanthematous 
diseases especially scarlatina. Ascarides sometimes find their 
way from the rectum into the vagina, and set up a severe irrita- 



618 A COMPENDIUM OF PRACTICAL MEDICINE. 

tion with discharge. Strumous children are very subject to this 
trouble. 

Prognosis. — This must depend upon the cause entirely. 

Treatment. — If the condition depend upon a constitutional 
€ause, the treatment must be general as well as local; but if to a 
local cause, treatment may be confined to the seat of the disease. 
The digestion and the bowels should be carefully attended to. 
Good food, warm clothing, and plenty of out- door exercise will 
aid in restoring the vigor of the general constitution. Frequent 
bathing, and rubbing the surface thoroughly with towels should 
not be neglected. In strumous cases, tonics, such as gentian, 
Colombo, nux vomica, with iron and cod- liver oil, will be of 
benefit. Aletris cordial, hydrastis, and cimicifuga have been 
recommended as having the effect of directly checking the flow. 
The local treatment may consist of applications to the parts of 
tincture of iodine, solutions of nitrate of silver, carbolic acid, 
chloride of zinc, etc. I have found in certain cases great benefit 
from the use of suppositories made after the following formula: 

Jfc Acidi tannici 

Acidi gallici 

Bismuthi subnitratis aa gr. iij-v. 

Olei theobromae q. s — M. 

Ft. suppositorium no. i. 
Sig. : Insert into the vagina after a douche of warm water at bed 
time. 

These suppositories used, one daily, for a time check the se- 
cretions and often effect a cure. If the trouble arises from lac- 
erations of the cervix, these should be restored by operations. 
If the trouble is due to endometritis or cervicitis a currettment 
of the uterus will often effect a cure. In any case the cause of 
the trouble should be diligently sought out and removed. 

VAGINITIS. 

Vaginitis or colpitis are terms used to designate inflamma- 
tion of the vagina. There are two forms, the acute and chronic. 
If the disease lasts a period longer than three weeks or a month, 
it is then spoken of as chronic, prior to this time as acute. Of 
the varieties of vaginitis we have the catarrhal in which inflam- 



VAGINITIS. 619 

niation of the mucous membrane is only so severe as to occasion 
a discharge of mucus or muco-purulent matter. Under this head 
are grouped nearly all of the ordinary inflammations of the va- 
gina, including the gonorrhceal. When the inflammation is of 
such character that a solid exudate is thrown out or into the 
mucous membrane we have what is termed exudative vaginitis. 
This form of inflammation is due to diphtheria. Sometimes the 
inflammation is situated within the connective tissue about the 
vagina. It is then known as the phlegmonous variety and is 
sometimes so severe as to occasion the sloughing of a great por- 
tion or all of the vaginal wall. 

Catarrhal vaginitis may occur from exposure to cold, from 
infection, from the introduction of foreign substances, from irri- 
tating injections, etc. In children it may be caused by the pres- 
ence of ascarides, byneglect of cleanliness, and by improper hand- 
ling of the parts. Vaginitis often follows attacks of the 
exanthematous diseases, but its most common cause is gonorrhceal 
infection. 

Gonorrhceal vaginitis is very apt to extend from the cervical 
canal to the endometrium, and from thence to the tubes and 
ovaries. It is also apt to spread to the urethra. 

Among the causes of vaginitis are excessive coition and mas- 
turbation. Old women sometimes are troubled with a very 
intractable form, the cause of which it is difficult to ascribe to 
anything but old age. 

The symptoms of vaginitis are those of inflammation else- 
where, as heat, pain, redness and a feeling of general discomfort. 
In the acute elevation of temperature frequently happens. 
Urination gives a sense of smarting. On examination the 
mucous membrane will be found to be red and swollen. Shortly 
after the onset of the trouble a discharge of mucus begins from 
the membrane, soon followed by pus. If the urethra is involved 
as it is likely to be, pressure along it with the linger will usually 
be followed by the discharge of a few drops of pus from the 
meatus. If the inflammation does not subside within three or at 
most four weeks, it is said then to have become chronic. At this 
time usually the symptoms will have in large measure subsided, 
except the discharge, which may continue copious and purulent. 



620 A COMPENDIUM OF PRACTICAL MEDICINE. 

Gonorrhceal vaginitis is particularly liable to become chronic. 
The diagnosis of vaginitis is readily made out on examination 
with the speculum and the vivid red membrane is at once noted 
with the discharge. Care should always be exercised that a 
diagnosis of vaginitis be not made from the discharge alone, for 
that may come from the interior of the womb, from a pelvic 
abscess, from malignant growths, etc. The question often arises, 
can we say with certainty whether a given case of vaginitis is of 
gonorrhceal origin or not. There has been much controversy 
regarding the matter, but the best authorities affirm that the 
j^resence of gonoccoci is conclusive proof of gonorrhceal origin. 

Prognosis. — Is good in a large proportion of cases, but when 
it becomes chronic it may last for years. 

Treatment. — Patients with acute vaginitis should remain in 
bed or at least keep quiet while the acute symptoms last. The 
bowels should be kept open with salines, the diet restricted, and 
hot water injections given twice daily. If the parts are much 
swollen, poultices of emollient substances, as linseed meal or 
chamomile flowers, may be applied. Tampons saturated with 
glycerine and laudanum may be inserted, giving much comfort 
to the patient. After the acute symptoms have subsided, solu- 
tions of mercury bichloride (1 to 5000) may be injected with 
benefit. Solutions of permanganate of potassium are also recom- 
mended as injections. In this stage of the trouble I have found 
suppositories containing tannic and gallic acid with sub -nitrate 
of bismuth to be of great value. Internally ol. santal, bals. 
copaiba and cubebs may be given with benefit. 

METRITIS. 

We understand by the term metritis an inflammation of the 
uterus. As of inflammations elsewhere we recognize the acute 
and chronic forms. Of these forms there has been by different 
authors, a variety of classifications which will not be here con- 
sidered. Metritis is one of the most common troubles of the 
uterus. A variety of terms have been applied to inflammations 
of the uterus designed to indicate the part of it, involved in the 
trouble as, endometritis, meaning inflammation of the mucous 



METRITIS. 621 

membrane lining the uterus; parenchymatous or corporeal metri- 
tis, inflammation of the muscular portion or body; cervicitis, in- 
flammation of the cervix and enelocervicitis, inflammation of the 
lining membrane of the cervix. Seldom, if ever, does the body 
of the uterus (the muscular layer) become inflamed except as 
an extension of the disease from the mucous membrane. The 
mucous membrane of both the body of the uterus and the cervix 
may be quite severely inflamed for a long period of time without 
its extension to the muscular layer. 

Metritis is, in the vast majority of cases, due to either gon- 
orrhoea, or is a sequence of the puerperal state, but may be due to 
other causes as, gynecological operations, the introduction of a 
sound, currettment, etc., when done without proper aseptic pre- 
cautions; or it may be caused by exposure to cold and wet, 
especially at the time of menstruation. Metritis sometimes fol- 
lows the exanthematous diseases as well as typhoid fever and 
syphilis. 

Symptoms. — The acute stage of metritis is accompanied by 
fever, the uterus is painful to the touch, and the patient com- 
plains of cramp -like pains in the lower part of the abdomen. 
JNfausea and vomiting are usual, and diarrhoea, with painful 
urination. Menstruation is often profuse, but is sometimes com- 
pletely suppressed. With these symptoms is an abundant dis- 
charge of purulent matter from the uterus. Especially is this 
true when the metritis is due to gonorrhoea. On vaginal exam- 
ination the uterus is seen to be inflamed, and is very tender to 
the touch. The prognosis is usually favorable, but the disease 
may extend to the tubes and ovaries, when it becomes difficult to 
cure. If it continues three or four weeks, becoming chronic, the 
jDrobability of a rapid and complete cure is greatly diminished, 
and especially if there is evidence that it has extended to the 
tubes and ovaries. 

Treatment of Acute Metritis. — The patient should remain in 
bed while the acute symptoms continue. To relieve the pain, 
heat should be applied to the abdomen. Sometimes the applica- 
tion of cold in the acute stage (as an ice bag to the lower part of 
the abdomen) will give comfort, but cold should not be applied 
if there is menstrual suppression. Douches of plain hot water 



622 A COMPENDIUM OF PRACTICAL MEDICINE. 

should be given as often as three times daily or more frequently 
if they give comfort. Sometimes hot water is not well borne, 
then tepid water should be tried. Flax-seed and slippery elm 
have been recommended as a valuable addition to the water. If 
the pain is very severe it may be necessary to administer an 
opiate, which is best given in the form of a suppository. Tam- 
pons saturated with boroglyceride and glycerine in the propor- 
tion of Sj. boroglyceride to O.j. of glycerine, introduced into the 
vagina, will produce a profuse watery discharge and relieve the 
congestion and pain. Ichthyol and glycerine may be used in the 
same manner with benefit. 

Gonorrhoea! metritis is treated best by washing out the 
uterus once a day with bichloride solution (1 to 2,000), until the 
acute symptoms have subsided, when the endometrium may be 
painted (twice weekly) with a 10 per cent, solution of nitrate of 
silver. Curretting the uterus and packing with iodoform gauze 
is effective. The gauze acts as a drain and keeps the uterus 
free from pus. If these more active methods of treatment cannot 
be adopted in a given case of gonorrhoeal metritis, the treatment 
for acute metritis not of gonorrhoeal origin, as described, can be 
adopted, together with the internal administration of anti-blenor- 
rhagic drugs, as bals. copaibse, ol. santal, etc., though these reme- 
dies should be given in smaller doses than to men. 

Chronic Metritis proceeds from the acute form, or is slowly 
developed from a lesion of structure at some point of the uterus, 
which allows of the introduction of infection. The most com- 
mon form of lesion productive of chronic metritis are the lacera- 
tions of the cervix, so frequently following child bearing. 
Usually in these cases the uterine tear has prevented the return 
of the uterus to its normal size after labor and a condition of 
subinvolution exists. The whole organ may be involved or only 
the cervix, or as often happens the inflammation is confined to 
the mucous membrane lining the cervix and is then called enclo- 
cervicitis, or to the mucous membrane of the body, then called 
endometritis. Tumors, malignant and non-malignant, may act 
as predisposing causes of chronic metritis. A condition of 
hardening sometimes follows long continued inflammation and 
anaemia of the uterine structure, the tissue becoming cicatricial in 



METRITIS. 623 

character when it is known as uterine sclerosis. The condition 
is incurable and function of the uterus practically ceases. 

With chronic metritis we have the prominent symptom of 
pain. The patient often complains of a "bearing down" sensa- 
tion, is troubled with cramps, and frequently with an irrita- 
ble bladder. Dysmenorrhea is usually an accompaniment of 
metritis with prolonged menstruation, and frequently bloody dis- 
charges in the interval between the menstrual periods. Some- 
times, however, in very weak patients, the condition is accom- 
panied with menstrual suppression. Usually there is copious 
leucorrhcea, and the appearance of this discharge is character- 
istic. From the cervix it resembles much the white of eggs, 
and from the uterine body is milky in appearance. The general 
symptoms are, loss of appetite, with nausea, dyspepsia and con- 
stipation. The patient often loses flesh, becoming anaemic and 
and weak. Backache and pain in the lower abdomen is usual. 
The patient is hysterical and melancholy, and usually remains 
sterile. On vaginal examination, if the disease is a result of 
child-bearing, we find the os patulous, the cervix enlarged and 
inflamed, possibly studded with hard nodules (the follicle of 
Naboth), and showing evidences of laceration. Care should al- 
ways be taken not to confound cancer with inflammation. When 
the cervix is hardened with inflammation and the follicles en- 
larged, they may present very similar appearances. A currette, 
however, will clear up the diagnosis. If the case is cancer, on 
curettment friable tissue is always brought away. If inflamma- 
tion, the tissues are firm, and the currette only makes the part 
bleed, and denudes it of a little mucous membrane. 

Prognosis — Of chronic metritis is uncertain, but a slow and 
tedious recovery is to be anticipated. 

Treatment. — -Patients suffering from endometritis should take 
plenty of rest. Employment that requires a great deal of exer- 
cise should be prohibited, especially work with sewing machines. 
The bowels should be kept open and sexual intercourse as much 
as possible interdicted. Bathing frequently should not be neg- 
lected. A sitz- bath occasionally will be found of benefit. Hot 
water douches should be given twice daily. If the cervix is 
much eroded, joainting the erosions with tinct. iodine com})., a 



624 A COMPENDIUM OF PRACTICAL MEDICINE. 

solution of nitrate of silver, carbolic acid, chloride of iron or 
chloride of zinc will be beneficial. Iodine is most commonly 
used. Applications of iodine may also be made from time to 
time to the endometrium with a bit of cotton wrapped upon a 
probe. If the remedies above recommended fail to cure, it will 
be best to thoroughly dilate the uterus, currette the endometrium, 
and if of very long standing, cauterize it with the actual cautery; 
or after the curettment the uterus can be packed with iodoform 
gauze or a drainage tube inserted and thoroughly drained. If 
the cervix is lacerated the laceration should be repaired. If the 
treatment proves of no avail and the disease has extended to the 
tubes and ovaries they may have to be removed. Constitutional 
treatment should not be neglected, as the administration of 
tonics, looking after the secretions, etc. 



CHAPTER IV. 
FIRST HELP IN SURGICAL EMERGENCIES. 



BY J. H. P00LEY, M. D. 



Prefatory. — The few desultory notes on various discon- 
nected subjects which make up this chapter are not intended as 
a complete discussion of any subject, but simply hints which may 
be referred to in an emergency and suggest some line of conduct 
which may be adopted while arrangements are made for regular 
and permanent treatment. Nothing new is offered, nor is there 
any pretense to novelty, even in the presentation of the subject. 
But sometimes the old and hackneyed, if apposite to the case, 
and easy of reference, is of more value at the time than the most 
learned and exhaustive discussion. If these suggestions prove in 
any instance of assistance to the young doctor, who is generally 
burdened with knowledge which he does not know how to use, 
they will not have been written in vain. 

BURNS. 

The extent of surface affected is of more importance than 
the depth or destruction of tissue involved. When a very large 
surface, especially over the trunk, is involved the prognosis is 
grave. The first attention in a case of burns includes both local 
and general treatment. Locally, tense blisters should be evacu- 
ated by small punctures and gentle pressure, and the epidermis 
allowed to fall down over the abraded surface. Any dressing 
that will exclude air will answer the purpose, though if con- 
venient carbolic acid may be added both for its anaesthetic and. 
its antiseptic properties. 



626 A COMPENDIUM OF PRACTICAL MEDICINE. 

Flour, freely sprinkled over the surface from a dredging 
box, is almost always available. 

Oil of any kind thickened with chalk, whitning, bismuth, or 
any similiar substance is an excellent dressing. The so-called 
carron-oil a mixture of linseed oil and lime water is a common 
application and efficient, but it is a nasty ill -smelling dressing. 

Prof. S. D. Gross highly recommended common white paint 
reduced to a proper consistence with oil and freely painted over 
the surface. He says that no fear need be entertained of the 
constitutional effects of lead. Cotton, though recommended by 
some, is a bad dressing, and only to be used when nothing else 
can be had. After the dressing, whatever it is, has been freely 
applied on pieces of soft old cloth, it should be retained by loose 
bandages. The pain of burns, especially of the superficial kind, 
is very severe, and demands the administration of opium or some 
of its preparations. These may be given freely in adults, but in 
children great care is necessary in their use. Shock, and in child- 
ren convulsions, are common in severe burns, and demand 
stimulants, such as spirits, hot beef tea, etc., by mouth or 
rectum. 

In cases where steam or heated air have been inhaled, severe 
inflammation of the mouth and fauces may result; the frequent 
administration of oil, or vaseline, or lard will give relief; if 
oedema of the glottis results, tracheotomy may be necessary to 
save life. 

COLD. (Exposure to). 

The effects of intense cold may be either general or local ; 
the first result of general exj^osure to cold is stimulating, but 
this is quickly followed by depression, pallor and coldness of the 
surface, with pain and numbness, followed by drowsiness, which, 
if indulged, ends in coma and death. Death from cold resembles 
apojxlexy. 

To restore a person insensible from exposure to cold, the 
patient should be placed in a cool room, the surface rubbed with 
snow, or flannel cloths, wet with whiskey or dilute alcohol. Arti- 
ficial respiration must be resorted to in extreme cases. When 
reaction begins, the temperature of the room may be raised, and 



COLD — DEOWXIM — DISLOCATION AND FRACTURES. 627 

the body wrapped up in warm blankets. Stimulants should be 
administered in moderate doses, at short intervals; if the patient 
cannot swallow, they may be given per rectum. Persevere in 
these efforts, as some cases have been rescued from apparent 
death only after hours of vigorous treatment. 

The local effects of cold are divided according to their sever- 
ity, into chilblains, and frost-bite. The frozen part at first ap- 
pears red, purple, or mottled, afterwards white or waxy, and is 
hard and stiff. Care must be taken not to restore circulation too 
rapidly. First rub the part with snow, afterwards with the warm 
hand, or some stimulating liniment. 

If gangrene results, treat locally with antiseptic dressings 
and await results. Constitutionally good food, tonics, and 
anodynes to relieve pain if present, are indicated. 

DROWNING. 

To resuscitate a person in a condition of suspended anima- 
tion from drowning, the body should first be inverted, held head 
downward for a few seconds, to let the water run out of the 
mouth, fauces, and (esophagus ; then removed to a warm room, and 
the surface dried and vigorously rubbed with woolen cloths. 
The tongue should be drawn well forward and artificial respira- 
tion practiced either by Marshal Hall's or Sylvester's method, 
care being taken not to repeat the steps of the process too rapid- 
ly. The great thing in these cases is perseverance. Vigorous 
efforts should be kept up at least half an hour, and if there is the 
least encouragement, much longer. When reaction begins it may 
be favored by mustard applications to precordia and spine, and 
hypodermic injection of stry china xo to tV gr- 

DISLOCATIONS AND FRACTURES. 

Until preparation can be made for reduction and permanent 
dressing of these injuries the limb should be placed in a com- 
fortable position and adequately supported. Care and gentle- 
ness should be exercised in the removal of clothing; it is 
frequently better to cut the clothes along seams, than to attempt 
removal in the ordinary way. As a temporary splint in case of 



628 A COMPENDIUM OF 'PRACTICAL MEDICINE. 

fracture, almost anything will answer, a pasteboard box, a maga- 
zine or paper- co vered novel, or a bundle of newspapers. In 
fracture of the lower extremity the so-called comforter splints 
serves an excellent purpose. This is prepared by taking an or- 
dinary bed comfort and spreading it flat upon a table or the 
floor; then two persons, one on each side, roll their respective 
halves into as compact and even a cylinder as possible. The 
limb is then placed between the two cylinders thus formed, and 
tied tightly with strips of bandage or handkerchiefs. This 
makes a very efficient and comfortable splint, for the first 
twenty -four hours or more, while arrangements are made for 
permanent treatment. 

FOREIGN BODIES IN EYE, EAR AND NOSE. 

Foreign bodies such as small fragments of coal- cinders, 
sand, straw, stone, steel, etc., may be either lodged in the folds of 
the conjunctiva, particularly the superior cul de sac, or impacted 
in the cornea. In the first, order the patient to look up while 
you depress the lower lid and carefully explore the lower cul de 
sac. Failing to find it here you direct him to look clown, then 
seizing the lashes of the upper lid you evert it over the end of a 
match, point of a pencil or your finger-tip; you thus expose the 
w r hole conjunctival surface, and cannot fail to find the particle if 
present, it is then easily removed with a camels hair brush, or 
the corner of a handkerchief. 

Pieces of granite or steel frequently become firmly impacted 
in the cornea of various workmen. The eye should be anaes- 
thetized by a few drops of a four per cent.solution of cocaine 
mur., when the body can be easily picked out with a cataract 
needle, point of a lancet or similar instrument. 

Foreign bodies in the ear are generally met with in children 
who often mischievously or carelessly thrust such things as but- 
tons, beads, pebbles, grains of corn, etc., into their own, or others 
ears. These bodies can almost always be removed by syringing 
with warm water; the auricle should be firmly drawn backward 
and a little upward, and the water thrown up the floor of the 
meatus with some force. This almost invariably succeeds if 
persevered in, and is perfectly safe. 



gas. 629 

Xo other attempt at removal should be made without full 
illumination, and clear sight of the object, which may then be 
removed by forceps, or a probe or ear spoon introduced behind 
it and used as a lever. 

Bodies similar to those put into the ears are also sometimes 
thrust up their nostril- by children. AYith a good light, the assist- 
ance of the ear mirror, and a little quickness and slight of hand, 
they do not often give much trouble. If they cannot be extracted 
they can sometimes be thrust backward into the throat. If left 
they are apt to set up a more or less violent inflammation, some- 
times with profuse, ill- smelling discharge; indeed the presence of 
such symptoms in a child should excite suspicion, and lead to 
careful search for some foreign body. I have known a head of 
timothy grass thus retained in the nose for many months. 

GAS. (Asphyxiation from). 

Persons not infrecpiently become asphyxiated from breath- 
ing for hours an atmosphere loaded with illuminating or natural 
gas. This may occur either accidentally or intentionally. Such 
persons are generally found profoundly insensible, breathino; 
slowly, perhaps stertorously, with a feeble pulse, perhaps no 
pulse perceptible at wrist, with pale or livid countenance and 
exhaling a strong odor of the gas. There can be no doubt of 
the advisability of blood letting in these cases, if the blood can 
be got to flow. It relieves the strain, and gets rid of some of 
the gas with which the blood is loaded. Other means of re- 
suscitation, sprinkling water in the face, holding ammonia to 
the nostrils, etc., together with artificial respiration should be 
tried. Of course doors and windows should be thrown wide 
open, even in cold weather. The gravity of these cases depends 
upon the length of time the patient has been breathing the 
poisonous atmosphere: but as in similar cases of asphyxiation 
by drowning, etc., we should persevere while there is a ray of 
hope, though the directly poisonous effects upon the nerve 
centres makes them a very fatal class of cas 



630 A COMPENDIUM OF PRACTICAL MEDICINE. 

HEMORRHAGE. 

As the various forms of internal hemorrhage are considered 
elsewhere in this work, we shall confine ourselves here to hemorr- 
hages from wounds. Hemorrhage from wounds where no consider- 
able artery is opened generally ceases spontaneously in a few mo- 
ments if freely exposed to the air, and many of the devices resorted 
to serve rather to keep up the bleeding than otherwise. The tem- 
porary control of hemorrhage, which is all we are considering 
here, can generally be accomplished by pressure either directly 
over the wound, or over the main artery, between it and the 
heart. Direct pressure is generally sufficient, especially when it 
can be made over a bony surface, as on the skull. In wounds of 
the extremities accompanied with severe bleeding, pressure 
should be made over the course of the principal artery, above 
the wound. This is most efficiently done by means of an elastic 
ligature or bandage. An india-rubber cord or tube, or an elastic 
suspender, or garter drawn tightly round the limb, generally 
suffices. If the blood is dark and the flow apparently increased 
by pressure above, it is venous, remove all bandages, and rely on 
direct pressure. Avoid styptics, especially cobwebs, which from 
the soot they often contain may leave an indelible mark, like 
a tattoo -mark. 

HERNIA. 

Hernia, or rupture, as it is commonly called, is a very com- 
mon affection. It consists in the protrusion, through natural or 
accidental openings, of some of the abdominal contents. The 
great danger in these cases is strangulation, which is preceded by 
inability to return the hernial contents to the abdominal cavity, 
as the patient has been in the habit of doing, it may be, for 
many years. This returning, or reduction of the hernia, is called 
taxis, and should be accomplished without force or violence. A 
physician or surgeon who is determined to accomplish the reduc- 
tion if strength of hand can do it, is a dangerous person. 

In performing taxis, bear in mind the anatomical direction 
in which the hernia must return, if at all. Then, after gently 
but persistently compressing the base of the tumor for a few 



HERNIA— INJURIES TO THE BRAIN. 631 

minutes, endeavor to return or push it back, remembering that 
the part that was last to come out must be first to go back. 
Should one attempt of this kind fail, the patient may be left for 
an hour or two with ice applied to the tumor, and then another 
effort made, under ether, being prepared, if this fails, to proceed 
with the necessary operation; the great danger in these cases 
being in delay. 

INJURIES TO THE BRAIN. 

Concussion or Compression. — -By concussion is meant a jar to 
the cranial contents, a molecular disturbance of the brain sub- 
stance, which may lead to loss of consciousness and other symp- 
toms, varying in gravity from a momentary dizziness to those 
which threaten to be fatal. Whether there can be any such con- 
dition without actual injury to brain substance or blood vessels 
is a matter of doubt, and likely long to remain so, as cases of 
concussion pure and simple give no opportunity for postmortem 
examination. Compression, or pressure upon the cranial con- 
tents may be immediate from depressed bone or hemorrhage; or 
later from inflammatory products. 

With the first only are we concerned; the diagnosis is not 
always easy. But if there is fracture with evident depression of 
bone, the accompanying symptoms are due to compression. In 
compression we have generally contracted pupil, small thready 
pnlse, often stertorous breathing, and generally paralysis (hemi- 
plegia). In concussion the pupils are dilated, or one dilated, 
the other contracted, in but few cases is consciousness com- 
pletely abolished, and there is generally nausea and vomiting. 

In all these cases of head injury the patient should be kept 
perfectly quiet, in a darkened room, and nobody allowed to ap- 
proach him except those that are absolutely necessary. The 
head should be elevated, and ice or cold water compresses ap- 
plied. If the vital powers are very much lowered, as indicated 
by pale and cool surface, small and irregular pulse, artificial 
heat by means of hot bottles, water- bags, etc., should be applied. 
Stimulants, if given at all, should be used with care in small 
doses, and at considerable intervals. In those cases which are 
accompanied with great restlessness, or convulsions, or severe 



632 A COMPENDIUM OF PRACTICAL MEDICINE. 

pain, morphine may be given hypodermically with advantage. 
The old-fashioned practice of bleeding, or administering an 
active purgative in these cases, is of doubtful utility at the best, 
and may do more harm than good. Above all, bear in mind 
Percival Pott's celebrated aphorism, as true to-day as when it 
was first uttered: a No injury of the head is so slight as to be 
despised, or so grave as to be despaired of." 

POISONED WOUNDS. 

Under this head we mean especially wounds received in the 
dissecting room, or in making post- mortem examinations, the 
latter of which are the more dangerous. These wounds are gene- 
rally upon the hand or fingers; after letting water run over the 
part for a moment, or just rinsing it in water, apply to the mouth 
and suck with all the force possible, then cauterize thoroughly 
with nitrate of silver, which though of very feeble power as a 
caustic, coagulates the albuminous fluids in and about the wound, 
forming barrier to absorption, and perhaps neutralizes the 
poison itself. In the absence of the nitrate any strong acid or 
alkali, or tincture of iodine, may be used, or even strong alcohol. 
In snake -bite, a ligature tied tightly between the wound and the 
heart, with strong suction, should be practiced at once, pending 
the arrival of professional assistance. In bites from suspected 
dogs, Mr. Youmans, who is certainly high authority, places great 
reliance on the application of nitrate of silver. 

POISONING. 

In cases of poisoning or suspected poisoning, there are cer- 
tain general measures which may be taken even when the nature 
of the poison is unknown, or before a proper antidote can be 
procured. Prominent among these is the production of free 
vomiting by any means at hand, such as salt and water, mustard 
and water, tickling the fauces- with a feather, or the finger. 
After vomiting has been produced let the patient drink large 
quantities of warm water, or if there is much pain and irritation 
diluent drinks, such as milk and water, soap and water, flax- 
seed tea or the like if procurable. If there is a tendency to 



POISONING SHOCK. 633 

drowsiness this should be combatted by every means in our 
power, keeping the patient walking about, switching the surface 
etc., etc. In poisoning cases all suspicious powders, mixtures, 
vials etc., should be taken possession of, and preserved pending 
the result, as they may be of the utmost importance later on. It 
would always be well also to preserve the matter first vomited. 
Keep your eyes wide open, observe everything, and say nothing. 

SHOCK. 

This is the sudden depression of the vital powers, brought 
about by accident or injury. The factors which enter into the 
cause of shock are various. Among them may be mentioned 
extensive destruction of parts, pain, when severe or protracted; 
this is exemplified in the case of extensive burns; hemorrhage, 
mental impressions, and direct assault upon nerve centres. 
Shock, even to a fatal degree, has been the result of evil tidings 
suddenly communicated, or of blows upon the epigastrium, 
when no serious injury could be recognized. 

The principal symptoms are, more or less, complete loss of 
consciousness, with or without delirium, pain, or its complete 
absence even when frightful mutilation has been sustained. 
Palor and coolness of surface, sub -normal temperature, weak, 
flickering pulse, or absence of pulse at wrist, and, in extreme 
cases, niufned and imperfect heart sounds, sighing, irregular res- 
piration, cold sweat, especially about the brow; and when there 
has been much hemorrhage, jactitation and thirst. Death may 
result in a short time, or the patient may recover even after a 
very severe and protracted attack. Generally reaction begins in 
two or three hours. 

The treatment of shock consists entirely in efforts to restore 
the vital powers, or as it is technically phrased to bring about 
reaction. Any hemorrhage that is going on must be stopped. 
The patient placed in a warm bed in the horizontal position, 
with the head low. Sometimes it is advantageous to raise the 
foot of the bed. External warmth should be promoted by hot 
water bottles or bags; or hot bricks or irons, care being taken 
not to burn the patient, who is not in a condition to give warn- 



634 A COMPENDIUM OF PRACTICAL MEDICINE. 

ing when applications are too hot. Stimulants should be admin- 
istered in extreme cases by rectum or hypodermically. If given 
by the mouth, care is necessary lest an overdose be administered, 
as absorption as well as other functions is in abeyance, and if 
the stomach be rilled with alcohol an injurious amount may be 
absorbed when reaction comes on. Where great pain or rest- 
lessness is present, or there has been much hemorrhage, opium in 
some of its forms may be freely given. As a general rule, 
operations should be postponed till reaction is established or at 
least well began; but this rule does not apply to cases of abdom- 
inal injury where operation may be called for. In such cases 
the operation should be proceeded with as speedily as possible, 
.as the only way of preventing a fatal result. 

SPRAINS. 

By a sprain is understood a wrenching, stretching, or rupt- 
ure, partial or complete of the ligaments of a joint, or its partial 
dislocation. The ankle is the joint that most frequently suffers, 
&nd there are all possible degrees in the severity of the injury. 
Pain is generally severe, and somtimes accompanied by nausea or 
vomiting, there is always more or less discoloration (ecchymosis) 
sometimes quite extensive. The best immediate application is 
hot water, this should be applied as hot as can be borne, and 
frequently changed. This application may be continued for 
twelve or twenty-four hours, after which it is of doubtful util- 
ity, and should be followed by a snug, smoothly applied flannel 
bandage. If swelling and pain persist after two or three days 
the joint should be immobilized by a plaster of Paris bandage, 
to be retained two or three weeks, and then reapplied if neces- 
sary. When pain and swelling have nearly disappeared, but 
there is still some stiffness and pain on motion, rubbing with 
some anodyne liniment may be of use. A sprain often leaves 
some weakness, with occasional pain in the joint for years. 



CHAPTER V. 

ANAESTHETICS AND THEIR MODE OF 
ADHINISTRATION. 



Ancesthetics are those agents which are employed for the 
prevention of pain, especially when used in surgical practice and 
during labor. They are likewise used to produce relaxation of 
muscles, when needed in reducing dislocations and hernia, or in 
setting fractured bones. They may be also resorted to in 
making diagnosis in cases of obscure abclominial tumors and in 
supposed malingering. 

Anaesthesia may be produced by benumbing the part to be 
operated on by means of cold, by intercepting nervous commu- 
nication, and by arresting the activity of the nervous centres 
concerned in sensation. They may be local or general in their 
action (Horwitz). 

The Introduction of Anaesthetics. — This great event has cast 
a wide- spread influence upon the progress of surgery. In 1842 
Crawford W. Long, of Georgia, removed a tumor with the pa- 
tient under the influence of an anaesthetic. Xo further attempt 
was made until 1844, when Wells had a tooth extracted while 
insensible with nitrous oxide gas. Morton, at the suggestion of 
Dr. Jackson, anaesthetized a patient on October 16th, 1846, while 
Dr. J. C. Warren removed a tumor from the patient's neck. 
From this time on, anaesthesia, hitherto a dream, now became a 
living reality. To Jackson, Morton and Wells, the profession is 
indebted for this great discovery, which is the greatest boon to 
suffering humanity. 

There is one sad event, however, connected with this dis- 
covery, and that is the melancholy termination of the life of 
each of the three men associated with it. Jackson died insane: 



636 A COMPENDIUM OF PRACTICAL MEDICINE. 

Morton died without worldly means; Wells became a pauper 
and was arrested in New York city as a criminal for throwing 
vitriol. He was sent to jail, and there committed suicide "by 
cutting his femoral artery. It is interesting to note in this con- 
nection, that Sir Edward Jenner, the discoverer of vaccination, 
was awarded $225,000 for his discovery by an act of Parliament, 
while by no act of the United States Government has anything 
been done to perpetuate the memory of these three men. The 
physicians of Hartford have erected a statue to Wells (Dennis). 

Important Anaesthetics. — The important anaesthetics are: 1. 
Ether. 2. Chloroform. 3. Nitrous oxide gas. 4. Bichloride of 
methylene. 5. Bromide of Ethyl. 

Physiological Actions. — When the vapor of ether or chloro- 
form is inhaled, a sense of f a ucial irritation and of the need of air 
is experienced, and more or less cough is produced. The irrita- 
tation of the fauces excites the flow of mucus, and the reflex act 
of swallowing. The feeling of the need of air causes the patient 
to push aside the inhaler or sponge, and in children may 
lead to violent struggling. The irritation soon ceases and the 
inhalation then proceeds quietly. The first effect is a general 
exhilaration, the pulse increases in frequency, the respirations 
become more rapid, the face flushes, talking, laughing, crying, 
singing, and sometimes praying indicate the cerebral intoxication. 
This stage of excitement varies in duration in different individu- 
als. At this period, although the patient can be easily aroused, 
sensibility to pain is decidedly diminished. If the inhalation be 
continued, the patient passes into the condition of complete 
insensibility. 

In women and children, and males reduced by illness, the 
production of insensibility, if the anaesthetic be not inhaled too 
rapidly, takes place quietly; but if the subject be a robust male, 
in full health, the stage of insensibility is preceded by a tetanic 
convulsive stage, in which the voluntary muscular system and 
the respiratory muscles become rigid, the breathing stertorous, 
and the face cyanosed. If the inhalation of the anaesthetic be 
pushed still further, the tetanic rigidity subsides, the cyanosis dis- 
appears, the breathing proceeds quietly, and a condition of com- 
plete muscular relaxation, and of abolition of reflex movements, 



ANAESTHETICS. 637 

is established. When this is accomplished, the arm drops with- 
out resistance when let fall, the conjunctiva is insensible to irrita- 
tion, the pupils do not alter in size when exposed to light, and 
there is no consciousness of pain. The surface is cool, and bathed 
with abundant perspiration, the countenance is placid, the eyes 
closed, the pupils rather contracted than dilated; the respiration 
easy, but more shallow than normal; the pulse slower — it ma} 7 be 
feebler, it may be stronger than in health. The functions of the 
cerebrum are suspended; only the lower centres, presiding over 
respiration and circulation, continue in action (Bartholow). 

Modes of Dying from Anaesthetic Vapors. — 1. By the first 
mode, the death is sudden and occurs very soon after the inhala- 
tion has begun, and is ascribed to "irritation of the peripheral 
nervous system, accumulation of carbonic acid in the blood, and 
arrest of the action of the heart.' ' The chloroform vapor seems 
to paralyze the cardiac ganglia. This accident sometimes occurs 
in persons who have previously taken the angesthetic without 
unfavorable symptoms of any kind. 

2. By the second mode, death ensues in the stage of rigid- 
ity preceding complete muscular relaxation, and is due to tetanic 
fixation of the respiratory muscles. In these cases respiration 
ceases before the pulsations of the heart cease. 

3. By paralysis of the respiratory muscles, death ensues 
during the stage of complete muscular relaxation, and the action 
of the heart continues for some seconds, or even minutes, after 
respiration has ceased. 

4. By paralysis of the heart. This also occurs in the 
course of complete insensibility; the motor ganglia are para- 
lyzed, and the heart suddenly ceases to act, the respirations con- 
tinuing for a short time longer. 

5. This mode of dying is made up of two factors : Depres- 
sion of the functions by chloroform narcosis, and the shock of 
the accident or surgical operation. Death may ensue during the 
inhalation, or may occur afterward (Bartholow). 

Conditions of the Organism Rendering the Use of Anaesthetics 
Dangerous. — 1. Experience has proved that old drunkards arc 
very unfavorable subjects. 



638 A COMPENDIUM OF PKACTICAL MEDICINE. 

2. When a tumor or abscess of the brain exists, it is dan- 
gerous to administer anaesthetics. 

3. Very much enlarged tonsils, swollen epiglottis, oedema of 
the glottis are contraindications. 

4. Emphysema and fatty heart are unfavorable conditions 
for an anaesthetic. Experience has demonstrated that those 
reduced by illness, and the feeble, bear anaesthetics better than 
the healthy and robust; that children and women are better sub- 
jects than men; that anaesthetics are safer when given for opera- 
tions for disease than for injury. 

5. Incomplete anaesthesia is a condition of danger. Many 
accidents have occurred from trivial operations— particularly 
extraction of teeth — before complete insensibility. In such cases 
the heart, enfeebled by chloroform narcosis, is suddenly par- 
alyzed by the reflex action proceeding from the peripheral injury 
(Bartholow). 

The chloroform committee of the Royal Medical and Chir- 
urgical Society of London formulated the following rules for the 
administration of anaesthetics: 

1. Anaesthetics should on no account be given carelessly or 
by the inexperienced; and when complete insensibility is desired 
the attention of the administrator should be exclusively confined 
to the duty he has undertaken. 

2. Under no circumstances is it desirable for a person to 
give an anaesthetic to himself. 

3. It is not advisible to give an anaesthetic after a long fast 
or soon after a meal, the best time for its administration being 
four or five hours after food has been taken. 

4. If the patient is much depressed, there is no objection to 
his taking a small quantity of brandy, wine, or ammonia before 
commencing the inhalation. 

5. Provision for the free admission of air during the patient's 
narcotism is absolutely necessary. 

6. The recumbent position of the patient is preferable; the 
prone position is inconvenient to the administrator, but entails no 
extra danger. In the erect or sitting posture there is danger 
from syncope. Sudden elevation or turning of the body should 
be avoided. 



ANESTHETICS. 639 

7. An apparatus is not essential to safety if clue care be 
taken in giving the anaesthetic. Free admixture of air with the 
anaesthetic is of the first importance, and, guaranteeing this, any 
apparatus may be employed. If lint, or a handkerchief or a 
napkin is used it should be folded as an open cone or held an 
inch or an inch and a half from the face. 

8. Chloroform should invariably be given slowly. Sudden 
increase of strength of the anaesthetic is most dangerous. Three 
and a half per cent, is the average amount, and four and a half 
per cent., with ninety -five and a half per cent, of atmospheric 
air, is the maximum of the anaesthetic which can be required, 
given cautiously at first, the quantity within this limit being 
slowly increased according to the necessities of the case, the 
administrator being guided more by its effect on the patient 
than by the amount exhibited. Ether may be given more 
boldly. 

9. The administrator should watch the respiration of his 
patient, and must keep one hand free for careful observation 
of the pulse. 

10. When patients hold their breath, more air should be 
admitted; and when the movement of swallowung is seen, it 
should be accepted as evidence that the anaesthetic is stronger 
than necessary. On any sound of stertor fresh air should be 
admitted. 

11. The patient who appears likely to vomit while begin- 
ning to inhale the anaesthetic must at once be brought fully 
under its influence; the tendency to sickness will then cease. 

12. The occurrence during the administration of an anaes- 
thetic of sudden pallor, lividity of the patient's countenance, or 
sudden failure or flickering of the pulse, or feeble or shallow 
respirations, indicates danger, and necessitates immediate with- 
drawal of the anaesthetic until such symptoms have disappeared. 
The chin should be raised as much as possible from the sternum, 
and if this movement fail to open the larynx, the tongue should 
be pulled forward and the head drawn back. 

13. Nelaton and Marion Sims advise the inversion of the 
body, with the view of throwing what blood there is wholly to 
the brain, on the theorv that death from chloroform is, as a rule. 



640 A COMPENDIUM OF PRACTICAL MEDICINE. 

clue to syncope or to cerebral anaemia. In the more threatening 
cases, commence instantly with artificial respiration, whether the 
respiration has failed alone, or the pulse and respiration together. 
Galvanism may be used in addition to artificial respiration, but 
artificial respiration is on no account to be delayed or suspended 
in order that galvanism may be tried. In extreme cases, laryng- 
otomy may be required. 

Few, if any, are insusceptible to the infiuence of anaesthetics, 
from two to ten minutes being required to induce anaesthesia. 
The time varies according to age, temperament and habits. The 
mixture of alcohol one part, chloroform two parts, and ether 
three parts, which should be mixed fresh before use, should be 
given in the same way as chloroform alone, care being taken, 
when lint or a handkerchief is used, to prevent the too free 
escape of the vapor. In Vienna the favorite mixture is three 
parts of ether to one of chloroform. Billroth employs chloroform 
three parts, ether one part, and alcohol one part (Bryant). 

Preparation of the Patient for Taking an Anaesthetic. — 
Before giving ether, the kidneys should be interrogated, and the 
urine examined. If the kidneys are diseased, it may cause sup- 
pression of urine and death. In operations upon the bladder 
and urethra the shock of the operation and the effects of the an- 
aesthetic are very apt to produce suppression of urine. 

If we operate in the afternoon and the patient is aware of 
the operation, he should have no food after the morning meal. 
Always avoid solid food for six or seven hours before the time 
for the operation. This is to prevent vomiting which is liable to 
follow the administration of ether. Solid particles of food may 
be drawn into the larynx and produce death. Vomiting, as the 
narcosis subsides, is usual, and as the insensibility of the glottis 
persists for some time afterward, particles of food may be lodged 
in the chink, causing fatal suffocation. Several cases of this 
kind have been reported. There should be nothing binding 
about the patient's neck or waist. We should use certain means 
to anticipate vomiting. Before the inhalation is begun, it is 
proper to administer an ounce or two of whiskey or brandy. 
Five or six grains of the bromide of sodium are often given 
before the operation to prevent vomiting. But much more im- 



ANAESTHETICS. 641 

portant is tlie expedient proposed by Bernard, and afterward by 
Nussbauni, to premise a subcutaneous injection of morphine. 
Bernard proposed to administer the morphine before giving the 
anaesthetic. If the morphine be given, there is much less likely - 
hood of vomiting, and if the patient does vomit, it is not so ex- 
hausting. When the morphine influence takes place, the inhala- 
tion will proceed quietly without the struggling and coughing, 
and spasmodic breathing, which so interfere with the administra- 
tion of anaesthetics, especially of ether. The use of morphine 
snbcutaneously also lessens materially, if not prevents entirely, 
the stage of rigidity and spasm. The quantity of the anaesthetic 
required is much less, and the stage of insensibility more pro- 
longed, when morphine is thus given. 

Besides these advantages, there can be no doubt that this 
agent antagonizes the paralyzing action of the anaesthetic on the 
cardiac and respiratory centers, and prevents the subsequent 
shock due to the administration of the anaesthetic and the per- 
formance of a surgical operation. Bartholow proposed the use 
of morphine and atropine combined as being better than the 
morphine alone. 

When the anaesthetic is about to be administered, the 
operator should, by a cheerful and confident manner, remove the 
fears of the patient. None of the paraphernalia of the opera- 
tion to be perf ormed should be exhibited before the patient, and 
no remarks should be made in his hearing regarding his case, 
the anaesthetic sleep, or the surgical procedure. Only the physi- 
cian having the administration of the anaesthetic in charge, and 
the necessary assistants, should be present in the apartment. An 
abundant supply of fresh air should be insured to the patient, 
and all appliances required for resuscitation should be at hand, 
but not ostentatiously paraded before the patient. 

Inhalers. — The simplest apparatus only is required. Com- 
plicated inhalers have, as frequently as a towel or handkerchief, 
been used in fatal cases of chloroform narcosis. A cone made 
of stiff paper, and a towel, with a sponge or absorbent cotton in 
the bottom of it, and large enough to cover the nose and mouth 
of the patient, is the best form of inhaler for the administration 
of ether. Dr. Allis, of Philadelphia, has devised an inhaler 



642 A COMPENDIUM OF PRACTICAL MEDICINE. 

which is much commended. When ether is inhaled, the atmos- 
phere is, as far as possible, excluded, in order that the anaes- 
thetic effect may be quickly induced. The important point in 
the administration of chloroform is to secure such an admixture 
of atmospheric air as that the amount of chloroform -vapor shall 
not exceed three and a half per cent. If this rule be regarded, 
the form of inhaler is of little importance. 

A cloth may be laid over the mouth and nose and the chlor- 
form dropped slowly on it. The mouth and nose should be pro- 
tected from the irritant action of the chloroform by inunction 
with oil or vaseline. Chloroform applied to the skin directly 
produces vesication, and this my be followed by permanent dis- 
figurement of the face. A cone made of a towel, having a large 
opening at the apex, and containing a suitable, very porous 
sponge, is now probably more employed than any other form of 
inhaler for giving chloroform. The typical method for admin- 
istering it is that of Snow: in a bag of suitable size the vapor 
of choloroform is mixed "with air in the proper proportion, and 
then given directly. In administering the vapor of chloro- 
form by any of the modes in use, it should not be forgotten that 
it has a density and weight four times those of air, and that, 
when a cloth is held closely over the mouth, the air is displaced, 
and the patient may be breathing little more than chloroform - 
vapor. During the administration of ether, attention should be 
directed to the state of the respiration, for arrest of the respira- 
tory movements is the only source of danger? When chloroform 
is being inhaled, the state of the circulation, as well as of the 
respiratory apparatus, must be regarded (Bartholow). 

Indications of Danger in Giving Anaesthetics. — If the patient 
becomes very much cyanosed, let up on the anaesthetic, 
and let him breathe some pure air or oxygen. If the pulse 
becomes irregular, let up on the anaesthetic. A rapid and feeble 
pulse, especially if irregular, is a very dangerous symptom. If 
the respirations become rapid and superficial, let up on the anaes- 
thetic. If the patient vomits, see to it that all foreign particles 
of food are removed. If the secretion of mucus collects in the 
throat, it should be wiped away with a sponge on a sponge - 
holder. 



ANAESTHETICS. 643 

Means of Removing Dangerous Symptoms. — If the heart fails, 
suspend the patient by the heels. This is to relieve the cerebral 
anaemia. If the respirations fail, we should have on hand a pair 
of forceps to grasp the tongue with, in case it falls back against 
the epiglottis, and the skin should be pinched over the dia- 
phragm to stimulate it to contraction, and the jaw should be 
pulled forward to get free ingress of air. The head should be 
only slightly raised. We should always have a Faradic battery 
and a few of the little pearls of nitrite of amyl at hand; the 
former is to perform artificial respiration, and the latter is to 
relieve the heart by dilating the blood-vessels, and thus dimin- 
ishing arterial pressure. Artificial warmth should be applied. 
Whiskey or brandy may be used hypodermically. Strychnine 
and atropine are the best respiratory stimulants, and are effective 
in ether narcosis (A. A. Smith and Bartholow). 

Choice of Anaesthetics. — Ether is safer than chloroform in 
prolonged surgical operations. Chloroform is more pleasant to 
inhale than ether, and should be used in operations about the 
nose, throat, tongue, or mouth, owing to the fact that ether is 
very irritating to the mucous membranes. Chloroform is irritat- 
ing to the skin, but not to mucous membranes. The stage of 
excitement is longer from ether than from chloroform. Chloro- 
form is more prompt in its effects, and the narcosis induced by 
it more sustained, than is the case with ether. The vapor of 
chloroform is not, and the vapor of ether is, inilammable, whence 
it follows that the former may be alone admissible at night under 
some circumstances. If the heart be diseased, ether is the anaes- 
thetic to be used. If the kidneys be diseased, chloroform is the 
proper anaesthetic. Vomiting and suppression of urine is more 
apt to follow ether than chloroform (Bartholow and A. A. Smith). 
A. C. E. mixture, -composed of alcohol one part, chloroform two 
parts and ether three parts, is useful when the operation is to be 
a very long one. It produces no cardiac depression unless used 
over twenty minutes. If a man has renal disease and a broken 
leg, the A. C. E. mixture is the proper anaesthetic. An old 
alcoholic is apt to have delirium tremens if he gets a broken leg, 
or a fracture of the skull, or any other injury. The A. C. E. 



644 A COMPENDIUM OF PRACTICAL MEDICINE. 

mixture is the anaesthetic to be used in these cases. This class 
of patients do not bear any form of anaesthetic well. 

After=Effects of Anaesthetics. — The after nausea and vomit- 
ing, which are sometimes most depressing, and occasionally dan- 
gerous, produced by anaesthetics, may be prevented by the hypo- 
dermic injection of morphine and atropine before beginning the 
administration of the anaesthetic. After the patient emerges 
from the anaesthetic sleep, the above mentioned unpleasant after- 
effects may be relieved by a minute quantity of morphine ( T V of 
a grain) and atropine (As of a grain) injected subcutaneously 
(Bartholow). 

After the operation, do not wake the patient, but let him 
sleep as long as he will. This lessens the liability to vomiting. 
After taking ether patients do not want anything to eat for some time 
Give the patient a cup of hot water as soon as he can take it after 
coming out from the ether. After ether taking give milk or 
beef- tea. 

It is necessary to surround the patient with warmth, as Dr. 
H. A. Hare, quoted by Ringer, has recently shown that pro- 
longed etherization considerably lessens the body temperature. 
He has reduced the temperature from 8° to 10° F., and in opera- 
tions he has seen a fall of 4.4° F. in man. Probably other 
anaesthetics produce the same effect. Some surgeons wrap 
children in cotton wool, covering not only the body, but also the 
extremities, before giving the anaesthetic. 

Anaesthetics in Midwifery. — Chloroform is to be preferred in 
labor, because more pleasant to inhale, more prompt in action, 
and without inflammability. Experience has shown that chloro- 
form is perfectly safe in labor when properly administered. 
When the labor is of short duration, and not excessively painful, 
anaesthetics should not be used; on the other hand, when the 
labor is protracted and the suffering great, they favor the pro- 
gress of the case and prevent exhaustion and uterine inertia. In 
labor, chloroform should not be given until conrplete dilatation 
of the os has taken place, the head descending and the pains 
propulsive. It should be inhaled only when the pains come on, 
and there is no doubt that its entire safety in obstetric practice 
is due to the intermittent plan of administering it. To relieve 



ANESTHETICS. 645 

the pain of labor, complete narcosis should not be produced, as 
cessation of uterine contractions and loss of uterine retractility 
may result, leading to a delay in the delivery, retention of the 
placenta, and even post-partum hemorrhage. The patient should 
take a full inspiration of the chloroform vajjor during the aura 
of a labor pain, and then bear down. About three deep inspira- 
tions are all that she will be able to take during any one pain. 
Toward the close of the second stage of labor, when the head 
begins to distend the external parts, the quantity of chloroform 
may be somewhat increased, but the inhalation should be dis- 
continued when the occiput' has passed under the pubic arch. 
Chloroform is said to favor laceration of the cervix and peri- 
neum, but this is not believed. 

Instrumental or manual interference with labor may render 
complete anaesthesia necessary, or it may be needed to aid in the 
relaxation of a rigid cervix, or to prevent the woman from bear- 
ing down when the perinseum is endangered by a too rapid de- 
livery. If puerperal convulsions occur at any stage of labor, 
the utility of chloroform is unquestionable. If the patient has 
valvular cardiac disease, this does not contra -indicate anaesthetics 
as was formerly thought. The shock, when an anaesthetic is not 
used, is more dangerous than the anaesthetic. Dr. A. A. Smith, 
of New York, considers organic heart disease as a special indi- 
cation for the use of chloroform. Give only enough to take 
away the acuteness of the pain. Give it during the "aura 11 of 
a pain for four or five pains, and then withhold it for a pain or 
two, in these cases of heart disease. When forceps or version 
are indicated in these heart cases, it is better to use ether, because 
it then becomes a surgical case, and should be treated as other 
surgical cases. Never use forceps, or perform version, or crani- 
otomy with the patient only partially under the anaesthetic. 
Finally, it is generally conceded that no well- authenticated case 
of death from the use of chloroform in labor has occurred, when 
the administration was in the hands of a properly qualified medi- 
cal man (Bartholow and A. A. Smith). Chloroform insensi- 
bility may, with care, be maintained for hours and even days. 

In administering anaesthetics, the attention should bedirected 
to the state of the pulse, the breathing, the conjunctiva, and (he 



646 A COMPENDIUM OF PRACTICAL MEDICINE 

pupil. If the pulse become quick and weak, or irregular, then 
the inhalation must be withheld. The breathing often affords 
an earlier sign of danger than the state of the pulse. If the res- 
pirations become shallow, and gradually less frequent, the anaes- 
thetic should be suspended for a time. 

The surest signs of safety, and the earliest of danger, are 
afforded by the state of the conjunctiva and pupil. While irri- 
tation of the conjunctiva causes reflex action, and is followed by 
blinking, there is usually no danger. The pupil is much con- 
tracted in the stages of insensibility when no danger is to be ap- 
prehended; but on the approach of jDeril from an overdose of the 
anaesthetic, the pupil dilates. 

It should in every case be made a rule that no operative 
measures of any kind be allowed until the patient is in the stage 
of relaxation. It is important to be able to obtain early warning 
that vomiting during narcosis from anaesthetics is about to super- 
vene. The pupil will, as was pointed out by M. Budin, afford a 
clue. He found, and my experience confirms his statement, that 
when the patient is about to vomit the pupils commence gradu- 
ally to dilate. Efforts at swallowing air are initiated at this 
time, and the pulse flags slightly. If now the anaesthetic be dis- 
continued, the pupils widely dilate, vomiting occurs, and the 
patient regains consciousness rapidly. But, on the other hand, 
if the administrator, aware of the import of these signs, pushes 
the anaesthetic, the pupils regain the contraction which is normal 
to the state of relaxation, and vomiting is obviated, while the 
pulse recovers its force. The gradual dilatation spoken of above 
must not be confounded with the sudden dilatation which be- 
tokens grave danger. In this last case, stertor, shallow breath- 
ing, and marked lessening .of the pulse-force also occur, together 
with cyanosis. 

It should be borne in mind that operations on the rectum 
and vagina, even when the patient is quite insensible, generally 
cause noisy catchy breathing, very much resembling stertorous 
breathing, often mistaken for it, and sometimes thought to indi- 
cate that too much of the anaesthetic has been inhaled; but this 
is not the case. The true state of things can be made out as 
follows: The noisy breathing does not occur until the rectum 



ANESTHETICS. 647 

and vagina are manipulated, and is especially loud and noisy 
when the finger or an instrument is passed with any force into 
either orifice. 

Are there any conditions of age or health which forbid the 
use of anaesthetics? Provided due care be observed, it may be. 
given to all persons, irrespective of their condition. It has been 
given in serious heart disease; in every stage of phthisis; in 
B right's disease, cancer, chronic bronchitis; to patients almost 
dead of exhaustion from loss of blood; to children of a few 
weeks, and to persons close upon a hundred years old. It is 
safe to say that any person fit for a severe operation is a fit sub- 
ject for an anaesthetic, but no one is so free from danger that 
care in watching its effects can be dispensed with. The cases 
requiring the greatest vigilance are not the young and delicate, 
for whom a small dose suffices, but the strong, who inhale deeply, 
and struggle much (Bartholow, Ringer and Bryant). It requires 
special study, combined with practice, to administer anaesthetics 
in the proper manner. In a great many operations, the skillful 
anaesthetizer is of more importance to the final success of the opera- 
tion than the operator himself. The experienced administrator 
takes a great load and responsibility from the operator's mind, 
reduces death from ether and chloroform to a minimum, and 
lessens the risks of every operation. 

Nitrous Oxide Gas. — Is not much used now as an anaesthetic. 
It is cumbersome since it requires an extensive apparatus. It is 
expensive. It was first used by Horace Wells, a dentist of Hart- 
ford. It is used at the present day principally in dentistry. It 
is not feasible for prolonged surgical operations. It causes cya- 
nosis and the pulse becomes increased in force and diminished in 
frequency. The patient will recover from it in three minutes. 
Some cases suffer for two or three days after its administration 
from a disturbance of the nervous system. It may cause sleep- 
lessness and muscular tremor. This gas is both a pleasant and 
efficient anaesthetic, more rapid and at the same time more tran- 
sitory in its action than either ether or chloroform. It is espe- 
cially adapted for the extraction of teeth, opening of abscesses, 
and similar minor operations. The amount necessary to produce 
anaesthesia is one to two gallons. It is best administered from 



648 A COMPENDIUM OF PRACTICAL MEDICINE. 

an India-rubber bag, containing about eight gallons of the gas. 

Bichloride of Methylene. — Is similar to chloroform and was 
first proposed as an anaesthetic by Dr. B. W. Richardson. It 
produces its effects more quickly and may be used in smaller 
quantity than chloroform. It is agreeable' to inhale and causes 
no heart depression. It is not used in this country at the present 
day, but is used in England a great deal, especially by Spencer 
Wells and his followers, who pronounce its vapor to be the best 
known anaesthetic. It does not produce any gastric disturbance. 
It is considered more dangerous than chloroform or ether. 

Bromide of Ethyl. — Is a quick anaesthetic. The odor is not 
unpleasant, and but little irritation of the air-passages is pro- 
duced. It is now seldom resorted to as an anaesthetic. It may 
cause almost instant death by paralyzing the heart. It is a dan- 
gerous anaesthetic. Ott states that it destroys life by a toxic 
action on the respiratory centre. 

Chloral as an Anaesthetic. — Dr. Bouchut recommends the use 
of chloral as an anaesthetic for children. He gives one dose, not 
exceeding forty-five grains, in children under three years of age. 
In half an hour the patient is asleep, and in an hour insensible. 
The anaesthesia lasts from three to six hours and is followed by 
no mrpleasant consequences. Thirty grains may be given with- 
out danger, Bouchut says, to children between two and five years 
of age (Bryant). 

Bonwell's Method of Introducing Anaesthesia. — Take a full in- 
spiration and then let the expiration go by installments. This 
must be done slowly and regularly. By this method, the sensi- 
bility will be benumbed so that the rectum may be examined. 
It may be used in opening an abscess and in pulling teeth. It 
will relieve many cases of insomnia. This method depends 
largely on the influence of the mind over the body. 

Deaths from the Different Anaesthetics. — Dr. Lyman has col 
lected thirty- seven fatal cases from the inhalation of ether, three 
hundred and ninety-three, from the administration of choloro- 
form, nine from the employment of bichloride of methylene, four 
which maybe attributed to nitrous oxide gas, and several from 
the use of ethyl bromide. 



CLINICAL INDEX. 



ABORTION.— Chloride of gold will avert the tendency to habitual abortion. Corn= 
utine, an alkaloid of ergot, will increase uterine action when required in abor- 
tion. Opium will check uterine action. Ergot will restrain the hemorrhage. 
AH drugs are dangerous to life when used in sufficient quantity to produce an 
abortion. 

ABSCESS — Belladonna, internally, will prevent the formation of abscesses in 
the neck and elsewhere, and after the onset of suppuration will check the 
pain and inflammation. Belladonna plaster will subdue the inflammation. 
Nitrate of Silver solution in nitrous ether applied over the inflamed area and 
adjacent region will abort the inflammation. Ointments or powder of iodol 
and iodoform are valuable. Counter=lrritation, byblistersor tincture of iodine 
around or adjacent to the abscess, is of great utility. Caustic potash or soda 
is sometimes used to open abscesses with the intention of preventing scarring. 
Sulphides, half grain every few hours, will abort abscess or hasten the forma- 
tion and extrusion of the pus. Ether may be used as a spray to produce local 
anaesthesia for opening abscesses. Poultices will check the formation of pus 
or assist in maturation. Fomentations, with a solution of 20 grs. carbonate 
of ammonium to one pint of boiling water, are of great utility in threatened 
mammary abscess. Iodine solution may be injected into the cavities of large 
abscesses after evacuation. Carbolic acid, boracic acid and permanganate of 
potassium solutions may be used for washing out cavities of abscesses. 

ACIDITY. — Mineral acids may be given shortly before meals for acid pyrosis, and 
after meals for alkaline pyrosis. Sulphurous acid may be given for acid fer- 
mentation with vomiting of pasty matter. Acid wine may be taken during 
meals. Alkalies may be given after meals for immediate relief, but are only 
palliative. Nux vomica in two or three drop doses just before meals is effi- 
cient in acidity of pregnancy. Gray powder in half grain doses three times 
daily may be given for acidity with clayey stools. Carbolic acid will stop the 
fermentation and eructation. 

ACNE. — Phosphorus may be given in acne indurata. Sulphur may be used inter- 
nally. Sulphur, dr. j., glycerine, oz. j., rose water, Oss , applied to the face, 
as a lotion, twice daily will be effective in acne of young women with disor- 
dered menstrution. Corrosive sublimate, one part; alcohol, enough to dis- 
solve it; water, 100 parts. A teaspoonful of this may be added to a quarter 
of a pint of water and the face sponged with it night and morning. Arsenic 
(Fowler's sol.) in two drop doses, three times daily, will prevent bromic acne. 
Bismuth may be dusted on the face when there are heat and redness. Sub= 
limbed sulphur applied as a powder to the eruption is one of the best applica- 
tions. Alkaline lotions, as liquor potassas dr. j. and aquae rosae oz. iv., applied 
with a soft sponge twice daily are useful when the skin is greasy and sebaceous 
follicles full. Hot sponging is effective in acne indurata. 

ADYNAMIA. — Alcohol in the form of whisk)', brandy or wine of good body, in tea- 
spoonful doses after meals is most useful. Give brandy when bowels are re- 
laxed, and whisky when there is constipation. Aliment, as beef, milk and cod- 
liver oil. Bitters, as quassia, gentian and calumba. Quinine in gr. ss.-gr. j. 
doses t. i. d. Iron may be given to stimulate digestion and promote blood for- 
mation. Nux vomica tincture in doses of three to five drops, t. i. d. is bene- 
ficial. 

AFTER-PAINS.— Chloral in large doses is effective. Camphor (ten grains) in a 
mixture with a little morphine (one-eighth of a grain) is a very efficacious 
remedy, florphine (gr. %) and atropine (gr. T ^), hypodermically, will give 
prompt relief. 

AGUE. — Quinine is by far the best remedy we possess for ague. In mild forms 
small doses several times daily and in malignant forms large doses continued 



650 A COMPENDIUM OF PRACTICAL MEDICINE. 

for a long time. Arsenic, in three to ten drop doses of Fowler's solution is the 
best remedy except quinine. Nitro=gIycerine may avert the cold stage. 

ALBUMINURIA.— The milk cure, especially butter-milk. Basham's mixture, tea- 
spoonful t. i. d., is of service in anaemic patients. Arsenic, three drops t. i. d. 
of Fowler's sol. after meals for kidney changes. Gallic acid has the power to 
restrain the waste of albumen in cases of acute albuminuria. It may be given 
as follows : Acidi gallici, dr. j., acidi sulphurici dil. dr. ss., tinct. lupuli dr. j., 
infus. lupuli oz. vj., m. Sig.: A tablespoonful three times daily. Gold and 
sodium chloride, in the dose of 1V2V g rain > t. i. d. is of the highest utility in 
chronic albuminuria. Nitro=glycerine ( T ^ gr.) daily, increased gradually will 
relieve the high arterial tension in acute and chronic Bright's disease. Digitalis 
may be used when the quantity of urine is much diminished. Pilocarpine may 
be used cautiously. 

ALCOHOLISM. — Bromides in drachm doses may be given for the "horrors." 
Arsenic, in drop doses before breakfast for the morning vomiting. Cimicifuga 
for the dyspepsia of drunkards. Morphine with tonics before meals for pain, 
nausea and want of appetite. Capiscum and nux vomica may be given as 
stomachic tonics. 

AMAUROSIS. — Strychnine will cure amaurosis of a functional kind, from lead, to- 
bacco and alcohol. 

AMENORRHCEA.— Aconite tincture in drop-doses every half hour, for sudden sup- 
pression of menses. Aloes and iron may be given when due to anaemia and 
torpor. Apiol in a dose of fifteen grains daily for five days before the expected 
period, is effective in amenorrhoea due to anaemia and torpor of the ovaries and 
uterus. Hydropiper in thirty minim doses of the fluid extract four times daily 
for a week before the menses ought to appear. Chloride of gold and sodium 
in 27 S r - dose thrice daily when dependent on torpor of the ovaries. Hot mus= 
tard sitz. baths for five days before the period. Potassium permanganate, one 
grain thrice daily for a week before the period. It may restore it after two 
years delav. 

ANiEMIA,— Cold sponging is useful in anaemia. Hypophosphites of lime and soda, 
a grain thrice daily. Phosphate of lime, a grain thrice daily, in anaemia of 
growing persons, and of women weakened by rapid child-bearing or excessive 
menstruation. Trinitrin in doses of one minim of the one per cent, solution 
gradually increased to many will cure many cases of anaemia. Quinine in 
doses of one grain three times daily, for badly fed, pale town-livers. Iron in 
all forms of anaemia. Arsenic is effective in proper doses. Wines with good 
body. Galvanism to stimulate the functions of organic life. 

AN>ESTHESIA.— Galvanism to the spine and affected parts. The electric brush 
is useful in anaesthesia. Strychnine, hypodermically, -^ gr. daily increased 
gradually. 

ANEURISM. — Potassium iodide, in full doses relieves the pain and promotes co- 
agulation of the blood in the sac. A low diet with absolute repose in the 
recumbent posture. Barium chloride one-fifth of a grain, three times a day for 
four weeks, then two-fifths may be given for months. Aconite slows the cir- 
culation and thus facilitates coagulation in the sac. Ergot, especially ergotin 
hypodermically has been very effective. Galvano=puncture has but rarely suc- 
ceeded. 

ANGINA PECTORIS.— Arsenic (Fowler's solution) in full doses, is very efficient to 
prevent attacks given during the intervals. Amyl nitrite, two to five drops 
by inhalation affords prompt relief in cases characterized by elevated arterial 
tension. Nitro=glycerine one minim of a one per cent. sol. at stated intervals 
is superior to amyl. Ether, in small quantity by inhalation, may abort a mild 
attack, hypodermically in the worst cases. Nitrite of sodium, one grain sev- 
eral times daily. Morphia, gr. J, may be given hypodermically for the pain. 

ANTHRAX.— Carbolic acid applied locally. 

APHONIA. — Atropine ( T ^y gr.) morning and evening will remove aphonia due to 
fatigue of vocal cords. It will also cure hysterical aphonia. Nitric acid in ten 
minim doses of the dilute, is effective in the hoarseness of singers and when 
aphonia is reflex. Electricity (galvanism) usually cures when due to paresis of 
the vocal cord. 

APHTH/E.— Bismuth subnitrate may be applied to ulcers. Potassium chlorate 
(gr. x. to oz. j.) may t be used (locally. Iodoform dusted on is an excellent topi- 



CLINICAL INDEX. 651 

cal application. Quinine in tonic doses (gr. ss. togr. j.) is highly useful. Car=» 
bolic acid (pure) may be applied to the ulcers, as an anaesthetic and alterant. 
Alum may be applied dry a few times a day to aphthous ulcers which will not 
heal. Borax with honey, or as glycerine of borax may be applied to ulcer. 

APOPLEXY. — Croton oil in one-third minim dose, may be given every hour as a 
purgative. Venesection or leeches, when the blood pressure is high and hem- 
orrhage threatened or proceeding. 

ASCARIDES — Quassia, an infusion, as a rectal injection, is one of the most ef- 
fective agents for the destruction of thread worms. Carbolic acid is an efficient 
but unsafe parasiticide when injected into the rectum. Iron, ten drops of the 
syrup of the iodide, three times daily by the stomach to prevent reproduction 
and dr. j. of the tinct. to Oj. of water by rectal injection. Santonin in dose of 
five grains for adult at night with or without calomel and a laxative in the 
morning. 

ASCITES. — Copaiba resin may be used as in the following: Res. copaibas dr. iij., alco- 
hol dr. v., spirit chloroformi dr.^ j., mucil. acacias oz. ij., aquas ad. oz. xij. — M. 
Sig.: A tablespooniul t. i. d. Pilocarpine very serviceable when given to pro- 
duce free diaphoresis. Jalap (compound powder) in teaspoonful doses taken in 
the early morning. Elaterium in dose of gr. T Vgr. I, must be given cautiously. 
Milk diet or dry diet will aid remedies. 

ASTHMA. — Oxygen, pure or diluted by inhalation. Amyl nitrite four or five 
drops by inhalation. Nitro=glycerine (gr. T ^) by the stomach. Arsenic one 
drop three times daily to prevent. Alum ten grains powdered and placed on 
the tongue is said to arrest a paroxysm. Bromides, in spasmodic asthma, may 
be given as follows: Potassii bromidi oz. j., potassii iodidi oz. ss., aquas 
oz. iv. — M. Sig.: A teaspoonful in water every half hour or hour. Chloral in 
twenty grain doses may arrest the paroxysm but danger of the chloral habit. 
Chloroform by inhalation relieves. Ether by inhalation is safer than chloro- 
form. Atropine gr. ■£$ at bed time may prevent paroxysm. Morphine (gr. J) 
and atropine (gr. T ^) hypodermically are the best agents to cut short a parox- 
vsm. Potassium iodide in full doses succeeds remarkably in some cases. 
Quinine may be given during the intervals in grain doses thrice daily. Strych = 
nine used persistently may lessen the number of attacks. Galvanization of the 
pneumogastric and cervical spmpathetic relieves the spasmodic difficulty of 
breathing and sometimes effects a cure, and faradization of the chest muscles 
has lately been reported successful in effecting a cure. Coffee, a very strong 
infusion, is often useful in a paroxysm. Lobelia tincture in ten drop doses 
every ten minutes till dyspnoea gives way. Stramonium, gr. xx. of the dried 
leaves may be smoked. Tobacco smoked sometimes gives relief. 

BALDNESS.— Pilocarpine may be used locally in the following formula: Extracti 
pilocarpin oz. j., tincture cantharidis oz. ss., linimenti saponis oz. iss. — M. 
Sig.: To be applied to scalp daily. 

BED-SORES — Alcohol in form of brandy to harden skin of parts exposed to pres- 
sure. Alum with tinct. of camphor and whites of eggs is a good topical appli- 
cation. Resorcin in form of powder may be dusted on. Copaiba and castor 
oil equal parts, locally. Naphthol as an ointment with vaseline is said to be 
the most efficient of all. Iodoform dusted over sores. Charcoal sprinkled over 
the black slough which is then covered with a poultice. Glycerine rubbed over 
the part exposed to pressure after washing morning and evening is one of the 
best preventives of bed-sores. Silver nitrate gr. xx. to oz. j. painted on the 
unbroken skin as soon as it becomes red to prevent bed-sores. 

BILIOUSNESS.— Mineral acids before meals in acid indigestion. Hydrochloric 
acid and pepsin after meals in atonic dyspepsia. Sodium p'hosphate in tea- 
spoonful doses thrice daily for a long time. Calomel and blue pill in small 
quantity as laxative merely. Ammonium chloride in five grain doses three 
times daily. Tincture of nux vomica, gtt. v., t. i. d. for three weeks. 

BITES. — Ammonia, weak solutions, in bites of insects to neutralize the formic 
acid. The strong aqua ammonia should be at once applied to the bite of ven = 
omous serpents and of rabid animals. Potassium permanganate, a strong 
solution applied locally. Alcohol stimulants internally. 

BLADDER, CATARRH OF.— Alkalies after meals, when the urine is acid. Ben- 
zoate of ammonia in gr. v. to gr. xx. thrice daily may be given when the urine 
is alkaline and loaded with phosphates. Copaiba, cubebs and juniper are use- 
ful. Cantharides, tinct. gtt. iij. to gtt. v. very useful. 



652 A COMPENDIUM OF PRACTICAL MEDICINE. 

BLADDER, IRRITABILITY OF.— Belladonna tinct. in ten minim doses until phys- 
iological effects. Alkalies when urine is acid. Benzoate of ammonia when 
urine is alkaline. Tinct. cantharides sometimes succeeds in irritable bladder 
of women. 

BOILS. — Arsenic, Fowler's solution, in three drop doses after meals for a long 
time when there is a succession of boils. Nitrate of silver gr. xx.-xxx, dis- 
solved in nitrous ether, and painted on early will abort boils. Sulphide of 
calcium half grain three times daily will hasten maturation and prevent the 
formation of fresh boils. No use in the boils of diabetes. Collodion may be 
applied in the papular or pustular stage. Belladonna with glycerine locally to 
allay pain. Counter=irritation by blisters or iodine around the boil. Menthol 
forty per cent, solution locally. Poultices assist maturation and allay pain. 
They may be smeared over with belladonna or opium. 

BRAIN, DISEASES OF.— Bromide of potassium in gr. xxx. doses at bed hour, 
when over-taxed from study, or over-application to business. Phosphorus 
sV to 3^ grain thrice daily for several months in cerebral softening and over- 
taxation. 

BREASTS, INFLAMMATION OF —Belladonna, especially as liniment to check 
secretion of milk when inflammation is imminent. When inflammation has 
set in, continuous application of belladonna for twenty-hours often arrests it. 
It is also useful when an abscess has formed. Digitalis as an infusion locally. 

BREATH, FOUL. — Camphor is a common ingredient of tooth powder and is a cor- 
rective of foul breath. Chlorine-water properly diluted. Carbolic acid in 
dilute solution as a mouth-wash and by the stomach. Potassium permanganate 
gr. ij. to oz. j. of rose-water as a mouth-wash. Tinct. of benzoin internally and 
as mouth-wash. 

BRIGHT'S DISEASE.— Milk=cure especially an exclusive skim-milk diet, or a diet 
composed largely of milk, has been very successful. Water and large draughts 
of weak alkaline waters. Bitartrate of potassae as lemonade, drunk freely as 
a diuretic. Digitalis the infusion for the dropsy. Potassium iodide in the 
chronic cases. Iron to relieve the anaemia. Pilocarpus highly useful in many 
cases of uraemia. Nitro»glycerine has proved highly useful when there is in- 
creased vascular tension. Cod=liver oil in the chronic. Tannin in chronic 
Bright's to lessen albumen. 

BRONCHITIS.— Aconite tinct. in small doses frequently in the acute form. Car= 
bonate of ammonia in gr. v. doses every three hours if the secretion is viscid. 
Morphine or Dover's powder with quinine may abort an acute attack if given 
early. Squills, the compound syrup with paregoric is useful. Terebene may 
be given for the cough. Cod=Iiver oil may be given in the chronic form. Iron 
as a tonic. Strychnine is the best remedy to check the reflex vomiting. Acids 
to lessen the secretion in the chronic. Tar, two grains in pill every three or 
four hours in chronic paroxysmal winter cough. Wine of ipecac used as a 
spray to the pharynx is invaluable in many cases of bronchial asthma and 
winter cough. 

BRUISES. — Capsicum, a strong tincture applied with gum is said to act like a 
charm on discolored bruises. Hamamelis applied on lint or cotton-wool. Sul= 
phurous acid a solution constantly applied. 

BUBO. — Iodine applied to produce vesication round a bubo relieves the inflamma- 
tion. Nitric acid may be applied to indolent and broken bubo. 

BURNS AND SCALDS.— Carbolic acid, a one per cent, solution on lint frequently 
renewed relieves pain. Cocaine as a lotion painted on scalds relieves the pain. 
Collodion painted over slight burns subdues inflammation. Lime in the form 
of lime-water combined with oil, enjoys a high reputation. Carbonate of soda 
in saturated sol. to relieve pain. Boracic acid most useful in Mr. Lister's 
hands. Carbonate of lead and linseed oil, white lead paint, is an excellent ap- 
plication to burns. 

CALCULI, BILIARY. — Aliment, as starches, sweets, and especially fats should be 
avoided. Alkaline mineral waters are highly useful. Sodium phosphate, dr. j. 
t. i. d. for three months. Turpentine and ether equal parts, gtt. x. t. i. d. for 
the solution and cure of biliary calculi. 

CALCULI, RENAL. — Nitric acid very dilute as an injection for phosphatic calculi. 
Alkalies to dissolves uric acid calculi. Alkaline mineral waters as vichy, 
Bethesda, etc. 



CLINICAL INDEX. 653 

CANCER. — Arsenic relieves the pain and retards the growth of cancer of the 
stomach and also of epithelioma. Bismuth relieves the vomiting in cancer of 
the stomach. Carbolic acid, pure, as an anaesthetic before applying caustics. 
Arsenious acid, pure, may be used to set up active inflammation in epithelioma. 
Carbonic acid may be injected up the vagina in cancer of the uterus to relieve 
the pain. Chloral in ten grain doses t. i. d. has relieved most severe pain of 
cancer. Chloroform as a vapor to raw, painful surface. Conium may be ap- 
plied as poultice to ease pain. Glycerine of carbolic acid and glycerine of 
tannin combined checks the discharge and stench of uterine cancer. Iodoform 
applied locally relieves the pain of cancerous sores, florphia dissolved in 
glycerine and" spread on lint, is very useful where there is much pain. Opium 
is also used in cancer of the stomach. Poultices of starch applied cold soothe 
open cancers. Warm enemata relieve the pain and straining in intestinal 
cancer. 

CANCRUM ORIS.— Arsenic in medicinal doses useful. Nitric acid applied to the 
surface. 

CANKERY TASTE.— Podophyllin small doses ^ grain nigfht and morning. Pur= 
gatives as mercury and podophyllin, are best. Water, half a glass of pure 
cold, daily, half hour before breakfast. 

CARBUNCLE. — Arnica as an ointment on plaster. Belladonna with equal part of 
glycerine as a local application to allay pain. Carbolic acid and glycerine 1 to 
4 on lint to sinuses. Iodine applied round the carbuncle reduces inflammation. 
Menthol, ten to fifty per cent, in ether or alcohol, painted on several times 
daily. Opium, an extract of the consistence of treacle applied three or four 
times a day. 

CARIES.— Phosphate and carbonate of lime to furnish needed materials. Cod= 
liver oil to promote constructive metamorphosis. 

CATARRH, ACUTE— COMHON COLD.— Aconite tinct. and belladonna tinct., 
equal parts', two drops of the mixture every half hour for six or eight hours 
and then every two hours. Quinine gr. xv. and morphine gr. ss. may at the 
outset, abort an attack. Dover's powder in full dose of gr. x-xv. at the incep- 
tion may arrest the attack. Iodide of potassium gr. v , tartar emetic gr. ss., 
syrup of orange peel oz. j., water oz. iij. — M. Sig.: Teaspoonful doses hourly 
for children. Warm foot=bath before going to bed. Turkish bath is useful in 
chronic catarrh. Carbolic acid is of great value by inhalation of vapor and 
spray. 

CATARRH, CHRONIC NASAL — Alum in powder, may be insufflated. Iodoform 
and tannin may also be applied by insufflation. Iodine in vapor may be in- 
haled. Ethyl iodide five to twenty drops put on a handkerchief inhaled every 
three hours. Sanguinaria ten drops of the tincture t. i. d., and the local ap- 
plication of the powder. Cubeb in powder by insufflation. 

CATCH IN THE BREATH.— Cold sponging night and morning will improve or 
even cure this curious complaint in infants. 

CHANCRE. — Eucalyptol with iodoform may be applied to both kinds of sores. 
Iodoform may be dusted over soft chancres. Iodol dusted over sore is effective. 
Nitric acid applied by means of a glass rod or pine stick to the chancre is one 
of the most valuable caustics. Acid nitrate of mercury is the most efficient 
escharotic for the destruction of chancre which we possess. Carbolic acid may 
be applied pure in mild cases. Chlorate of potassium in powder is also an ex- 
cellent local application. Iodide of iron internally is valuable. 

CHANGE OF LIFE. — Aetata is one of the most useful remedies for many of the dis- 
tressing symptoms occurring at the change of life. Ammonia in the form of 
Raspail's sedative lotion to be applied to the painful part of the head in the 
headaches of this period. Bromide of potassium in gr. xx.-xxx. doses at bed- 
time, for the despondency with sleeplessness and irritability often also with 
heats, flushings and perspirations. Calabar bean for the flatulence of this 
period. Change of air and scene where other treatment fails. Eucalyptol for 
various symptoms as palpitations, flushings and flatulence. Iron the tincture 
of the chloride gtt. xv. t. i. d. in fluttering of the heart with fullness of the 
head, heat and weight on the vertex, frequent flushings and hot and cold per- 
spirations. Nux vomica tinct. gtt. ij. and opium tinct. gtt. ij. combined t. i. d. 
are most useful. 

CHAPS. — Collodion is sometimes used but for chapped hands and lips glycerine of 
starch, arnica cerate or eau de cologne and glycerine better. Compound 



654 A COMPENDIUM OF PEACTICAL MEDICINE. 

tinct. of benzoin and glycerine, equal parts, is the best remedy for chapped 
hands and lips and fissured nipples. Sulphurous acid and glycerine, equal 
parts, combined are most useful for chapped nipples, Vaseline and petroleum 
are effective. 

CHEST PAINS. — Iodine, as an ointment, in muscular pains of the chest. Belia= 
donna is better when the pain is in the skin. 

CHILBLAINS.— Sulphurous acid is an efficient application to chilblains, applied 
as follows: Acidi sulphurosi dr. iij., glycerine dr. j., aquae oz. iss. — M. 
Benzoin tincture applied locally is the best. Turpentine is efficient. Balsam of 
peru in ointment for broken chilblains. Capsicum tinct. painted over un- 
broken chilblains. Iodine tinct. or ointment is better painted over the part. 
Carbolic acid may be used as follows: Acidi carbol. dr. j., tinct. iodi dr. ij., 
aciditannici dr. ij . , cerat. simplicis oz. iv. — M. Sig\: Ointment. 

CHLOROSIS —Arsenic, gtt. iij. of Fowler's sol. t. i. d. after meals. Hypophos= 
phites of lime or soda may be given in grain doses, t. i. d. for some time. Iron 
reduced gr. v., t. i. d. gives excellent results. Iron may be given with rnan = 
ganese or arsenic or with aloes if constipation exists. Water of iron spring 
most beneficial. Massage with inunctions of oil. Nux vomica may be com- 
bined with iron. Pepsin and pancreatin aid digestion. Galvanism and 
faradism to the central nervous system. 

CHOKING. — Bromide of potassium gr. iij. -v. t. i. d. to a child six years old, which, 
from the time of his birth, can swallow solids with ease, yet is choked every 
time he tries to drink. 

CHOLERA, ASIAT1CA.— Morphia, gr. %-±, hypodermically, of the greatest value 
even in the stage of collapse. Mercury in form of gray powder, gr. \ hourly is 
of the greatest service in infantile cholera. A starch injection with a minute 
quantity of laudanum assist the gray powder. Arsenic, Fowler's sol. with 
opium of service. Camphor gtt. iv.-vj. of the strong spirit, every ten minutes 
at first then hourly. Chloral combined with morphine as follows: Chloral 
hydratis dr. iij., morph. sulph. gr. iv., aquae laur-cerasi oz. j — M. Sig.: Fif- 
teen to thirty minims. Chloroform a few drops frequently to stop vomiting. 
Calomel, minute doses (gr. 2V) every hour will sometimes stop vomiting. AI= 
cohol in form of iced brandy to stop vomiting. Acetate of lead with opium and 
camphor as follows: Plumbi acetat. grs. xxiv., pulv. opii grs. xij., pulv. cam- 
phorae dr ss., sacch. alb. q. s., Ft. pulv. no. xij. Sig.: One powder every hour. 
Chlorodyne very effective. 

CHOLERA HORBUS — Horphine and atropine (gr. ± and gr. 1-120) hypodermically 
is the most efficient remedy. Chloral with morphine if cramps occur. Carbolic 
acid and bismuth as follows: Acidi carbolici grs. iv., bismuthi subnitrat. 
dr. ij., mucil. acacias oz. j., aquas menth. pip. oz. iij. — M. Sig.: A tablespoon- 
ful every three hours. 

CHOLERA INFANTUM.— Carbolic acid is very effective. Bismuth subnitrate, gr- 
iij. every twb hours. Calomel in minute doses arrests vomiting. Oxide of zinc 
given in the following formula: Bismuthi subnitrat dr. iss., pepsinas sacch. 
dr. ss., zinci oxidi grs. vj-grs. xij. — M. Ft. pulv. no. xij. Sig.: One powder 
every four to six hours. Brandy is serviceable. 

CHORDEE. — Camphor, ten to twenty grains very successful. Potassium bromide 
dr. j., every four hours. Cantharides tinct. one drop thrice daily. Aconite 
tinct one drop each hour. Morphine gr. \ and atropine gr. 1-150, hypoder- 
mically will most certainly relieve. Tartar emetic will relieve if carried to 
nausea. Tobacco wine a few drops at bed-hour. 

CHOREA. — Cold effusions and cold bath. Cod=liver oil when the nutrition is poor. 
Iron may be given for the anaemia. Arsenic, Fowler's sol. gtt. iij. to x. t. i. d. 
very successful. Chloroform inhalation t. i. d. in severe cases. Strychnine in 
increasing doses until stiffness of the muscles of the neck and spasmodic jerk- 
ings. Hyoscyamus gr. 1-50 daily. Morphine in large doses. Chloral at night is 
highly useful. Conium is said to be good. Sulphate of zinc pushed to nausea. 
Galvanism to the spine. 

CIRRHOSIS.— Iodide of sodium or ammonium in small doses t. i. d. before meals 
in first stage. Phosphate of sodium, dr. j., t. i. d. for a long time. Gold and 
sodium chloride in doses of gr. 1-10-1-20 t. i. d. seem to have curative power if 
given in time. Arsenic, Fowler's sol. gtt. v, t. i. d. retards or arrests the over- 
growth of connective tissue. 



CLINICAL INDEX. 655 

COLD-FEET. — Sponging with vinegar and water or hot and cold water alternately. 
Ice to spine. Strychinia gr. 1-60 t. i. d. to promote capillary circulation. 

COLIC— For the flatulent colic of infants no remedy is better than mistura as- 
afoetidae which may be given in teaspoonful doses. Chloroform a few drops 
frequently useful in flatulent colic and in hepatic. Ether internally and by 
inhalation. Camphor, a few drops of the saturated tinct. frequently. Morphine 
and atropine hypodermically the most prompt and successful. Hot fomenta= 
tions in all kinds of colic. 

COLICA PICTONUM.— Sulphuric acid diluted gtt. x. t. i. d. flagnesium sulphate 
to overcome constipation. Morphine and atropine for pain. Iodides and bro= 
mides in proper doses to cause excretion of lead. 

COLIC, HEPATIC— Morphine and atropine hypodermically for the pain. Phos- 
phate of soda dr. j. doses t. i. d. for a long time to dissolve the calculi and 
prevent the formation of others. 

CONDYLOMATA.— Calomel dusted over. Nitric acid dilute solution as a wash. 
lodol dusted over. Iodoform powder applied freely. Carbolic acid undiluted 
applied to the part. 

CONJUNCTIVITIS.— Calomel dusted over the membrane. Bismuth in powder ap- 
plied directly. Ergot fluid extract, applied undiluted, very effective. Castor 
oil, a drop in eye, to allay pain. Yellow oxide of mercury gr. viij.-x. to oz. j. 
of vaseline is a most efficient remedy for granular lids. Zinc sulphate in the 
following formula is one of the best remedies: £inci sulph. gr. ij.-iv., mor- 
phinae sulph. grs. ij.-iv., atropine sulph. gr. ss., aquae rosae oz. j.— M. Sig.: 
One drop in the eye t. i. d. 

CONSTIPATION.— Aliment as unbolted Hour, corn-meal bread, fruits and vegeta- 
bles. Cascara sagrada in ten to fifteen minim doses t. i d. of the liquid ex- 
tract. Arsenic and nux vomica may be given. Faradizations of the intestines. 
Aloes with iron good in chronic cases. Saline mineral waters are effective. 
Podophyllum and the rhubarb and soda mixture very efficacious. Compound 
licorice powder in milk for children. Tobacco, a smoke after breakfast some- 
times efficient in habitual constipation. Enemata to unload the bowel, but 
habitually used is harmful. 

CONVALESCENCE.— Alcohol before or at meals in form of whisky or brandy. 
Fats, as cod-liver oil. Bitter tonics as gentian, colomba, etc. Lime water is 
useful. Pepsin and pancreatine are of service after meals. 

CONVULSIONS.— Ice should be applied to the head. Morphine gr. %, hypoder- 
mically in uraemic or puerperal. Chloroform and ether by inhalation. Choloral 
gr. v. for children. Bromide of potassium in all forms. Warm bath for in- 
fants and children. 

CORNS. — For the cure of corns no application is so certain, prompt and efficient 
as liquor potassae. It should be applied by means of a pine-wood splinter to 
the summit of the corn and the tissue softened by it scraped off. By successive 
applications the callosity is removed without pain. 

COUGH. — Paregoric in teaspoonful doses every three hours to a child eight years 
old. Cod=liver oil in chronic coughs. Creasote in winter coughs. Glycerine 
and lemon juice are effective. 

CROUP. — Ipecac the syrup, in teaspoonful doses every half hour until vomiting is 
produced. Alum dr. j. in honev or syrup every fifteen minutes until vomiting 
is produced. Hercury subsulphate in grs. ij.-v. is the most efficient emetic in 
croup. Quinine in large doses is highly useful. Carbolic acid in solution as a 
spray. 

CYSTITIS. — Alkalies to render urine neutral. Cantharides one drop of the tinct. 
t. i. d. Laudanum and starch injected into the rectum relieves the pain. 
Pereira, dr. ij.-iij. of the liquid extract every three or four hours for chronic 
cystitis. 

DANDRUFF.— Borax saturated sol. for sponging the head several times daily. 

DELIRIUM TREMENS.— Acohol may be of great service. Potassium bromide in 
dr. j. doses for the "horrors." Chloroform by inhalation to procure sleep. 

DIABETES. — All saccharine and starchy foods must be excluded. The milk-cure 
has succeeded remarkably in some cases. Butter=milk may be better. Alka= 
line mineral waters are of great value. Codeine restrains the waste of sugar. 
Gold and sodium chloride is a promising remedy. 



656 A COMPENDIUM OF PRACTICAL MEDICINE. 

DIABETES INSIPIDUS.— Ergot in large doses is the best remedy.' Dry diet. 

Iodide of potassium has cured cases of syphilitic origin. 
DIARRHOEA..— Bismuth subnitrate in dr. ss. doses t. i. d. Chalk=mixture with 

opium in diarrhoea of children. Calomel in small doses. Castor oil in the 
early stage to carry away the irritant. Camphor with or without opium for 
summer diarrhoea. 

DROPSY.— Digitalis infusion in tablespoonful doses t. i. d. Saline purgatives in 
general dropsy. Iodide of potassium in some cases of Bright's disease. Dry 
diet and milk-cure. Nitro=glycerine in gradually increasing doses in cases of 
high vascular tension. 

DYSENTERY. — Salol is highly efficient in arresting intestinal fermentation. 
Fowler's sol. with opium. 

DYSMENORRHCEA.— Hot sitz=bath two or three times daily. Aconite and pul= 
satilla for the congestive form. Amyl nitrite by inhalation, affords relief 
quickly. Gelsemium and apiol give relief in the neuralgic form. Ergot mav 
give relief. Morphine and atropine give prompt relief. 

DYSPEPSIA.— Milk=cure. Pepsin, ingluvin and pancreatine assist digestion in 
atonic dyspepsia. Muriatic acid after meals. Alkalies may be given after 
meals. Simple bitters may be gi /en with acids. Fowler's sol. drop doses, re- 
lieve irritative dyspepsia. Nux vomica and wild cherry useful stomachic 
tonics. Acohol in the form of wine in small quantity before meals. 

EAR-ACHE.— Morphinas sulphatis grs. iv., aquae destil. oz. j.— M. Sig.: Fill the 
external meatus with the solution. Cocaine, four per cent, solution, one drop 
in the ear is the most effective remedy. Water as hot as can be borne, fill the 
external meatus. Counter=irritation by blister behind the ear often relieves. 

ECLAITPSIA.— Morphine subcutaneously in uraemic form. Chloroform by inhala- 
tion. Chloral grs. xx. every two hours. Potassium bromide in dr. ss. doses 
every two hours. Pilocarpine in small dose must be watched. Veratrum 
viride dr. ss. of the fluid extract every fifteen minutes until nausea or vomiting 
ensue. 

ECTHYflA.— Quinia in full doses often effects a cure. Cod=Iiver oil internally 
and externally. Iodoform, iodol and naphthol useful topically. 

ECZEMA. — Arsenic, Fowler's sol. gtt. iij.-v. t i. d. after meals in chronic form. 
Bismuth subnitrate as a dusting powder to surface. Salicylate in powder freely 
to eruption. Tannin in powder dusted over. Boracic acid mixed with starch 
as a dusting powder. Atropine internally in acute cases. Electricity (galvan- 
ism) in chronic cases. Iodoform and vaseline in dry stage. Milk diet exclu- 
sively. Lime water and glycerine equal parts locally. Oxide of zinc ointment 
sometimes beneficial. 

EMPYEITA.— Carbolic acid, a weak sol. to be injected after evacuation. Iodine 
solution to be injected after tapping to prevent reaccumulation of pus. 
Chlorine solution for washing out the cavity. 

ENDOCARDITIS.— Quinine, a 20 to 40 grain dose at the onset to check the inflam- 
mation. Morphine gr. % to gr. ^, hypodermically, will sometimes abort ser- 
ous inflammation. Salicylic acid may be given in the rheumatic form. The 
potassium salts liquefy the exudation. 

ENDOMETRITIS.— Undiluted carbolic acid is an efficient application to ulcers of 
the cervix uteri, chronic endo cervicitis and endo=metritis. It may be ap- 
plied undiluted without risk to the mucous membrane of the uterine cavity on 
the cotton-wrapped probe, after preliminary dilatation of the canal. There is 
probably no better means of treating uterine catarrh. Iodoform and tannin 
applied locally. Chronic acid (grs. xv. to dr. j. of hot water) has been injected 
into the uterine cavity with success. 

ENERGY, LACK OF.— The Turkish bath, like sea-air and sea-bathing, is a true 
tonic in this condition. 

EPIDIDYMITIS.— The oleates of mercury and morphia ten to thirty drops are suf- 
ficient for one application. It should be applied twice daily for five days, then 
at night only for five days, and afterwards every other day until a cure is ob- 
tained. 

EPILEPSY.— Potassium bromide grs. xv.-xxx. t. i. d. for the diurnal variety. 
Chloral full dose at bed-time may prevent nocturnal attacks. Iron to prevent 
anaemia. Amyl nitrite inhaled when the aura is felt may prevent the seizure. 



CLINICAL INDEX. 657 

Nitro-glycerine may prevent an attack if given in time. Nitrite of sodium in 
grs. xx. doses t. i. d. 
EPISTAXIS. — Aconite tinct. in small and frequent doses check nose-bleed in chil- 
dren and plethoric people. Alum in powder insufflated or a solution injected. 
Cocaine four per cent. sol. applied locally to nasal mucous membrane. Tannin 
in solution locally applied. Compression of the facial artery Spinal hot 
water bag and a hot foot-bath. Ergot in grs. ij.-v., hypodermically, to con- 
tract blood-vessels. 
EPITrlELIOriA.— Carbolic acid applied undiluted to the cancerous sore and a 
syringef ul of a five per cent. sol. injected daily beneath the new formation. 
Salicylic acid (pure) may be applied in powder. Boracic acid finely levigated 
applied in -nowder. Dried sulphate of zinc may be dusted over the affected 
surface. Chloride of zinc one part and flour four parts may be dusted over 
the surface. Potassium chlorate (powdered) is thickly applied over the sore, 
and is said to allay pain and remove fetor. 
ERUCTATIONS, OFFENSIVE.— Mineral acids to correct the oxaluria on which the 

eructations depend. 
ERYSIPELAS, — Aconite tinct. one drop hourly until fever is reduced in facial 
erysipelas. Belladonna tinct. five drops every two hours along with the 
aconite. This has a real curative power. Quinine in full doses. Tinct. chlor- 
ide of iron in large doses. Carbolic acid (one per cent, sol.) applied to surface 
frequently on lint. Iodine tinct. paint affected surface and surrounding skin 
to prevent spreading. Nitrate of silver eighty grains to dr. iv. of distilled 
water, to be applied two or three to the inflamed surface and two inches be- 
yond. 
ERYTHEMA.— Bismuth subnitrate dusted over surface allays irritation. Hydro- 
chloric acid diluted gtt. x. internally t. i. d. Zinc, alum and lead as lotions. 
Quinine in tonic doses for some time. 
EXOPHTHALMIC GOITRE.- Iron for the existing anaemia. Digitalis good in some 
cases. Ergot of service to raise arterial tension and slow the heart. Galvan- 
ism in uncomplicated cases is decidedly curative. 
FAINTINGS.— Cold water sprinkled on the face. Ammonia to the nostrils. Brandy 

for feeble heart. 
FEET, FETOR OF.— Calicylic acid in powder freely dusted over the feet and stock- 
ing is very effective. Sodium bicarbonate a saturated solution locally. Po- 
tassium permanganate in solution will remove fetor temporarily. 
FELON. — Nitrate of silver a strong solution in nitrous ether applied over the part 

may abort it. Carbolic acid to benumb the surface during incision. 
FEVER. - Cold-baths. Tinct. aconite, one drop, tinct. belladonna two drops every 
hour until fever is reduced. Antipyrine grs. v. every two hours until three 
doses have been taken. Quinine in large doses. Phenacetine in grs. v. doses. 
FISSURE OF THE ANUS.— Forcible dilatation of the sphincter under an 
anaesthetic. Iodoform dusted well over the fissure. Cocaine to allay irrita- 
bility. Hydrastis the fluid extract applied undiluted. Bromide of potassium 
in five parts of glycerine locally. 
FISSURE OF THE NIPPLES.— Collodion applied to close fissure. Lime water as 
a lotion. A solution of iron subsulphate and glycerine applied with a brush to 
fissure. Tannin in powder to part Tinct. of benzoin with glycerine. 
FLATULENCE. — Avoid sugar, starchy food and tea. Asafoetida one drachm of 
the tinct. to oz. iv. of water, a tablespoonful for adults. Bismuth and char- 
coal equal parts, ten-grain doses. Chloroform in drop doses every fifteen 
minutes. A tumbler of hot water between meals. Camphor as follows: Aquae 
camphorae oz. iij., tinct. lavendulae comp. oz. j. — M. Sig.: A tablespoonful 
every hour. Turpentine gtt. iij. -v. on lump of sugar. 
FLUSHING HEATS.— Nitrite of amyl £ of a drop in five drops of rectified spirit 
t. i. d. Nux vomica tinct. and tinct. of opium, equal parts, four drops t. i. d. 
Bromide of potassium fifteen grains t. i. d. 
FRECKLES. — Biborate of soda, a saturated solution, is a safe and often successful 
lotion. The following lotion is useful: Potassi carbonatis dr. iij., sodii 
chloridi dr. ij., aquae rosae oz. viij., aquae aurantii flor. oz. ij. — M. Sig.: Lo- 
tion. 

GALL-STONES — (See Biliary Calculi). 



658 A COMPENDIUM OF PRACTICAL MEDICINE. 

GANGRENE. — Antiseptics, as carbolic acid, salicylic acid, resorcin, salol, iodoform 
and thymol are most effective. 

GASTRALGIA. — Arsenic one or two drops t. i. d. of Fowler's solution, is the most 
generally effective of all remedies. Chloroform two to five minims dropped on 
sugar and swallowed will relieve. Alum is useful in the cases with acidity and 
pyrosis. Injections of water under the skin over the epigastrium affords much 
relief. Bismuth, creasote and glycerine are useful. Nux vomica may remove 
the morbid state on which the pain depends. Morphine hypodermically s'tops 
the pain at once. Galvanism has been successful. Diet is of great importance. 

GASTRIC CATARRH.— Arsenic is the most important remedy. The milk cure is ef- 
fective. The bitters, as calumba, gentian, nux vomica and cinchona infusion 
are useful. Bismuth and alum are of service. 

GASTRIC ULCER.— Bismuth allays pain and arrests vomiting. Fowler's solution 
in drop doses lessens pain and vomiting. Horphine and atropine arrest pain 
and vomiting, even in very minute quantity. Milk-cure may be tried. Rectal 
alimentation may be necessary. Silver nitrate in solution promotes healing 
and relieves pain. 

GLEET. — Blisters to the perinagum are very beneficial. Iron when the subject is 
anaemic. Turpentine, juniper and cantharides tinct. may be tried. Bismuth 
half an ounce, glycerine half ounce and water three ounces, as an injec- 
tion t. i. d. 

GOITRE.— Electrolysis has succeeded in some cases. Red iodide of mercury oint= 
ment rubbed in, in the sunshine. Tinct. iodine injected into the gland applied 
locally. Iodide of potassium in ten grain doses internally. 

GONORRHOEA. — Avoid all alcoholic drinks. Alkalies to render urine neutral. 
Aconite tinct. one drop each hour in acute stage. Cantharides drop doses 
t. i. d. Bismuth with fluid ext. of hydrastis is one of the best injections. 
Chloride of zinc two grains to a pint of water injected hourly often removes 
the disease in twenty-four to forty-eight hours. Zinc sulphate two-grains to an 
ounce of water injected three to six times daily. 

GUMS, AFFECTIONS OF.— Glycerite of tannin for spongy and bleeding gums. 
Alum for the same condition as above. Carbolic acid when fetor is present. 
Benzoin tinct. may be applied to the gums. 

H/EflATEMESIS. — Iron subsulphate and pernitrate solutions, one or two drops, 
well diluted with ice-water and frequently. Alum especially useful in passive. 
Lead acetate may be used in all conditions. Ergot may be used in doses of half- 
fluid drachm. Ice to be sucked and small pieces to be swallowed. Tannin 
may be used in solution. Turpentine in five to ten drop doses frequently. 

HEMATURIA. — Camphor two to five grains when bloody urine is due to drugs. 
Cannabias indica is said to relieve this condition. Ergot may be given by the 
stomach. Gallic acid is one of the most useful remedies. Quinine is effective 
in malarial hematuria. Turpentine in very small doses. 

HAEMOPTYSIS. — Common salt half teaspoonf ul taken dry and repeated till nausea 
is induced. Digitalis infusion in large doses useful. Ergot thirty to forty 
minims overy two or three hours. Ice to be sucked. Morphia in small doses 
hypodermically. Gallic acid and ergot by the stomach. Spinal hot water bag 
to cervical and upper vertebrae. 

H/EnORRHAGE, CEREBRAL.— Venesection or leeches when blood pressure is 
high and haemorrhage threatened or proceeding. Purgatives may be given. 
E/rgotine, hypodermically, in two to five grain doses. 

H/EHORRHAGE, INTESTINAL.— Ice should be applied to the abdomen. Ergotine 
two to five grains subcutaneously. Opium (laudanum) in doses of thirty 
minims to quiet intestinal movements. Turpentine in small doses frequently. 
Sulphuric acid diluted in ten drop doses. Tannic acid in solution and other 
astringents. 

H/EMORRHAGE, UTERINE.— Ergot, fluid extract, in teaspoonful doses. Ipecac 
carried to nausea is highly effective. Turpentine one drachm every three 
hours. Monsel's solution diluted, injected. Tincture opium in one drachm 
dose with brandy. Ice or hot water in uterine cavity. Acid sulphuric diluted, 
small doses frequently. 

H/EflORRHOIDS. — Nitric acid half to one ounce in half pint of water, as a lotion 
to bleeding piles. Bromide potassium one part to five parts of glycerine lo- 
cally to ease pain. Potassium chlorate half to one ounce of a saturated solution 



CLINICAL INDEX. 659 

with ten drops of laudanum as injection to inflamed piles. Carbolic acid six 
grains, cocaine ten grains and glycerine one drachm. — M. Sig.: Inject ten 
minims into the tumor. 

HAY=FEVER. — Quinine is useful at the onset as a spray locally and later in tonic 
doses. Aconite is efficacious in the early stage. Ethyl Iodide by inhalation of 
service. Morphine is most beneficial in any stage. Cocaine to the nose, as a 
spray, is a very effective remedy. Potassium iodide ten grains at bed-time 
will often cut short the attack. Atropine in doses of a sixtieth of a grain when 
the secretion is profuse. 

HEADACHE. — Tea or coffee will relieve headache from nervousness or exhaus- 
tion. Belladonna three minims of the tincture every three hours, when pain is 
over brows and in eyeballs. Arsenic in three drop doses t. i. d. for neuralgic 
headache. Bromide potassium in thirty grain doses for sick or nervous head- 
ache. Sodium phosphate teaspoonful t i. d. in bilious headache. Acetanilid 
in five grain doses every thirty minutes until relieved or until three doses have 
been taken. 

HEART, DISEASES OF.— Horphine, hypodermically, in dilated heart and general 
dropsy therefrom. Iron is of great utility in the irritable heart of anaemia. 
Ergot is useful in dilated heart. Digitalis is remarkably beneficial in rapid ac- 
tion with low tension and valvular lesions. Bromide potassium in ten grain 
doses t. i. d. is useful for over-action and simple hypertrophy. Quinine in 
tonic doses for cardiac weakness. Atropine is a prompt cardiac excitant. 
Acohol in form of brandy or wine, when the heart is suddenly enfeebled by 
fright, loss of blood, accident, etc. Arsenic Fowler's sol. in three drop doses 
t. i. d. after meals, for breathlessness on exertion from weakly-acting heart. 
Strychnine in medicinal doses strengthens the heart beats. 

HEMIPLEGIA. — Strychnine by hypodermic injections into the paralyzed muscles 
most useful. Massage. Galvanism to brain and cord and farad ism to the 
to the muscles if they waste 

HEPATIC DISEASES.— Chloride of gold and sodium is effective in sclerosis. 
Phosphate sodium is one of the most useful and certain cholagogues. Am= 
monium chloride is useful in catarrh of the bile-ducts. Rhubarb, aloes and 
podophyllum are effective. Nitro=muriatic acid is useful in ten drop doses 
t. i. d. in torpor of the liver. 

HERNIA.— Chloroform by inhalation to assist reduction. 

HERPES.— Morpha oleate applied locally in herpes zoster. Iodine liniment ap- 
plied once. Hot fomentations will often disperse the development of herpes 
labialis. Calomel and zinc ointments are curative. Galvanism in cases of 
herpes zoster. 

HICCOUGH.— Morphia grs. % hypodermically. Apomorphia gr. T V, hypoder- 
mically, will sometimes cure. Mustard one drachm infused in four ounces of 
boiling water has cured obstinate cases. 

HOARSENESS.— Turkish bath at the onset will cut it short. Borax the size of a 
pea dissolved in the mouth. Ipecac wine as a spray to throat. Alum as a 
spray, ten grains to an ounce of water. Nitric acid is highly effective in 
hoarseness of singers and reflex from the stomach in ten minim doses of the 
dilute acid. Atropine in hysterical aphonia. 

HYDROCELE.— Iodine tinct. injected into the sac after removal of the fluid. 
Carbolic acid and nitrate silver a strong solution injected in the same way. 

HYPOCHONDRIASIS.— Patassium bromide fifteen grains t. i. d. Gold and sodium 
chloride in gr. jVto doses -t. i. d. gives excellent results in the hypochondria 
of the aged. Laudanum in small doses is a remedy of the first importance. 
Arsenic gives good results in the aged. Asafcetida in cases with flatulence. 

HYSTERIA.— Cod=liver oil and the "rest cure " are useful. Aconite tinct. for flut- 
tering of the heart in nervous persons. Potassium bromide in large doses pre- 
vents paroxysms. Opium, a drop of laudanum with two of the tinct. of nux 
vomica four times daily for weight on head and flushings. Valerian useful 

IMPETIGO. — Quinia in tonic doses very efficient. Mineral acids in cases of indi- 
gestion. Zinc ointment applied relieves. Sulphur internally is of service. 
Poultices may be applied at night to remove scabs. Glycerine of tannin is a 
good application. Sugar of lead in solution may be applied. 

IMPOTENCE. — Strychnia in large doses sometimes useful when spermatorrhoea ex- 
ists. Cantharides tinct. in twenty to thirty drops t. i. d. with iron and nux 



660 A COMPENDIUM OF PRACTICAL MEDICINE. 

vomica very useful. Cannabis indica and phosphide of zinc stimulate the func- 
tion. Ergotine a hypodermic injection about the dorsal vein of the penis. 
Ergot by the stomach increases the vigor of the erections. Gold and sodium 
chloride increase sexual activity in gr. ^ t. i. d. 

INCONTINENCE OF URINE.— Belladonna tinct. ten to twenty drops t. i. d. is the 
best remedy for children. The child should be waked at midnight to pass 
water. Ergot said to be useful when due to paresis of bladder. Iron syrup of 
the iodide in ten drop doses t. i. d. in anaemic subjects. Collodion painted to 
form a cap over end of prepuce. Chloral is sometimes effective in children. 
Strychnia good in old people with paralysis of the bladder. Cantharides 
tinct. two drops t. i. d. 

INDIGESTION.— Acid hydrochloric ten minims t. i. d. of the diluted acid. Lactic 
acid good in atonic dyspepsia and indigestion. Alcohol in small doses is an ex- 
cellent stomachic tonic. Bismuth for painful indigestion and nausea. Aloes 
in indigestion with torpor of large intestine and pasty motion. 

INSOMNIA.— Potassium bromide in thirty grain doses at bed-hour. Paraldehyde 
thirty to fifty minims is said to be very effective. Chloral is the most direct 
and generally useful hypnotic in fifteen to twenty grain doses at bed-time. 
florphine and atropine hypodermically is the best sleep producer in cases of 
pain, mania, and melancholia. Alcohol is efficient when due to cerebral 
anaemia. Warm bath at bed- hour often succeeds. 

INTERTRIGO.— Bismuth subnitrate dusted over the surface. Tannin in powder is 
a useful application. Zinc ointment is very efficient in some cases. 

INTESTINAL CATARRH.— Ammonium chloride five grains t. i. d. is a valuable 
remedy. Salol is a useful drug- into three to five grain doses t. i. d. after 
meals. Bismuth is one of the best remedies. Calomel in minute doses fre- 
quently is of great service. Hydrastis is a useful drug- in this condition. 

IRITIS. — Atropine two to four grains to the ounce, a drop or two in the eye, four 
to six times daily to prevent adhesions. Hserine to break up adhesion and di- 
minish intra-ocular tension. Mercury in specific iritis. 

JAUNDICE. — Mercury, in form of gray powder, gr. ^ four times daily at the onset, 
is very valuable. Calomel in small doses gives good results. Benzoic acid, to 
remove bile from the system. Sodium phosphate, a teaspoonful t. i. d. very 
useful. Skim=milk cure. Ammonium chloride gr. v. t. i. d. is beneficial. 
Nitro=muriatic acid dil. in ten minim doses t. i. d. Rhubarb, aloes and podo= 
phyllum are excellent remedies in this condition. 

JOINTS, DISEASES OF. — Blisters, a succession of them about the joints, in cases 
of synovitis. Nitrate silver, grs. xx. to an ounce of nitrous ether, is an efficient 
application to check inflammation. Oleate of mercury and morphine rubbed 
into the joint is of great service in inflammatory affections of joints. - Galvan- 
ism and massage are highly useful. 

LACTATION. — Atropine, four grains to the ounce of rose water, applied on lint to 
the gland to arrest secretion. Phosphate of lime is highly useful in the debility 
of lactation. 

LARYNGITIS.— Aconite tinct. in small doses frequently. Tannin and glycerine 
applied to the throat. 

LEUCORRHCE A.— Bicarbonate of potash, or soda one drachm to a pint of water 
when discharge is alkaline. Carbolic acid, one drachm to a quart of water. 
Alum, one drachm to a pint of water, is a useful injection. Zinc sulphate may 
be used also. Iodoform and tannin packed about the cervix is highly useful. 
Acetate of lead properly diluted is an excellent local application. Bismuth 
may be combined with fluid extract of hydrastis. 

LICE. — Bichloride of mercury solution destroys lice on all parts of the body. All 
the essential oils will destroy lice. 

LUMBAGO. — Chloroform, a few drops injected deeply, is remarkably beneficial. 
Galvanism usually effects a cure. Faradism is sometimes useful. Morphine, 
hypodermically, affords prompt relief. Heat to the back for three hours. 
Massage is curative in some cases. 

MENORRHAGIA.— Ergot is very useful in all forms. Gallic acid sometimes suc- 
ceeds well. Potassium bromide in fifteen to thirty grain doses t. i. d. often 
arrests promptly. Cinnamon, the oil in drachm doses given several times 
daily, is highly recommended. 



CLINICAL INDEX. 661 

MYALGIA.— Massage will usually do good. Galvanism will surely cure. Faradism 
may succeed. Acetanilid is an efficient remedy. Laudanum, applied with 
friction, gives relief. 

NEURALGIA. — Morphine, hypodermically, is the most efficient remedy for the 
relief of pain. Galvanism is the most decidedly curative agent, flassage gives 
much relief. Iron, for the existing anaemia. Bromide potassium is useful in 
some cases. Arsenic will benefit some cases. Strychnine long continued in 
depressed states of the nervous system. Anaesthetics promptly relieve. Ace= 
tanilid will relieve in some cases. 

OBESITY.— Acids, alkalies, bromides and potassium permanganate will promote 
destructive metamorphosis. 

ORCHITIS.— Mercury, the oleate painted over. Ice in a bag kept applied. Iodine 
tinct. locally applied. Nitrate of silver in nitrous ether painted over. 

PARALYSIS. — Strychnine, injected into the muscular substance, is of the greatest 
utility in all forms of paralysis, but must be used after local trouble in the 
nerve-centers have subsided. Phosphorus should be given to restore nerve- 
matter, and in hysterical paralysis. Cod=liver oil is useful to restore nervous 
matter. Ergot is useful in some cases. Iodide of potassium in paralysis due 
to gumma. Galvanism and faradism are first in importance in the treatment 
of paralysis. Massage is an important adjunct to other kinds of treatment. 

PEMPHIGUS. — Arsenic, Fowler's sol., five drops t. i. d. after meals, for chronic 
form. Belladonna tinct., five minims t. i. d. for the acute. 

PERITONITIS. — Morphine, hypodermically, is the most efficient drug. Must be 
given freely. Quinine in full doses at the onset. Turpentine when there is 
tympanites, especially useful in puerperal peritonitis. Aconite for the fever at 
onset. Locally, ice-bag to abdomen; counter-irritation; heat; poultices; leeches. 

PERSPIRATION, EXCESSIVE.— Belladonna, as a liniment, locally to the affected 
part, and tinct. internally. Ergot is said to arrest sweating. Picrotoxin, a 
minute dose, will stop for several nights the sweats of consumption. Atropine 
for " night-sweats. " Pilocarpine in ■£$ grain doses thrice daily. Oxide of zinc 
in two grain doses nightly to control profuse colliquative sweating. 

PHARYNGITIS.— Silver nitrate two grains to the ounce of water is effective in 
many cases. Tannin locally, in powder or solution. Hydrastis is an excellent 
topical application. It may be taken internally in doses of five to ten drops 
t. i. d. 

SALIVATION. — Alcohol diluted as a gargle. Iodine two drachms of the tincture 
to eight ounces of water. Acids in small medicinal doses as astringents. Bro- 
mide of potassium very beneficial in salivation of pregnancy. 

SCABIES.— Carbolic acid locally to destroy the parasite. Sulphur after a warm 
bath with soap and water, rub in ointment composed of two parts of sulphur, 
one of carbonate of potash and eight of lard. Clothing, submit all clothing 
which cannot be boiled to a temperature between 250° and 300°. Sulphate of 
copper used as a lotion is successful. 

SCIATICA. — Methylal a twenty per cent, mixture with oil, rubbed in along the 
nerve is effective. Morphine hypodermically. Chloroform and ether injected 
deeply in old cases is beneficial. Poultices applied very hot. Galvanism very 
effective. Nitrate of silver inject ten to twenty drops of the solution deeply 
near the affected nerve. Aquapuncture is much used recently. 

SCLERODERriA.— Cod=Iiver oil an important remedy. Galvanism (central) is 
recommended. Phosphates and hypophosphites with or without cod-liver oil. 

SCROFULA.— Calomel ointment to sores The Phosphates are very beneficial to im- 
prove the nutrition. Iron long continued is useful. Tinct. of iodine applied over 
scrofulous glands. Cod-liver oil is of great service. Chloride of calcium in ten 
to twenty grain doses in milk after food is effectual in enlarged glands and 
chronic diarrhoea. 

SEA=SICKNESS.— Chloral fifteen to thirty grains every four hours. Spinal ice= 
bag sometimes of service. Nitro glycerine has been recommended. Chloro- 
form one drop by the stomach frequently repeated. Bromide of soda one-half 
to one drachm taken before embarking is the best remedy. Morphine in small 
doses hypodermically. Nitrite of amyl inhaled for prevention. Nitro=gIycer- 
ine by the stomach is useful. 

SLEEPLESSNESS.-(See Insomnia). 



662 A COMPENDIUM OF PEACTICAL MEDICINE. 

SNEEZING.— Iodine inhalations in sneezing with itching of nose. Camphor inhal- 
tions or the powder sniffed up the nose is useful in sneezing with running 
from nose and eyes. Arsenic one drop of the liquor three times a day in 
sneezing of asthma Iodide of potassium ten grains several times daily. 

SORE-FEET.— Washing soda, one tablespoonful to one-half gallon of warm water 
as foot-bath. 

SORES. — Alum in powdered form to secreting sores. Iodoform is good used as a 
dusting powder over all forms of sores. Opium and glycerine as an applica- 
tion for pain. Sulphate of zinc is applied locally to sloughing sores with bene- 
fit. Carbolic acid, boracic acid and salicylic acid are applications of great 
value as antiseptics, deodorants and alteratives. Potassa chlorate in powder 
is remarkably beneficial. Camphor as a dusting powder is effective. 

SPERMATORRHOEA.— Nux vomica is useful as a tonic. The tincture of the 
chloride of iron and arsenic are remedies of value when anaemia is present. 
Belladonna, one-fourth grain of the extract with one and one-half grains of 
zinc sulphate three times a day is often of use. Camphor in large doses may 
be used with benefit. 

SPRAIN.— Cold douche with salt added is beneficial to relieve stiffness. 

STINGS.— Weak solutions of ammonia are effective. 

SUN=STROKE. — Cold douche when patient is struck down unconscious. 

SWEATING. — Atropine is very efficacious in sweating of phthisis, one-sixtieth of 
a grain at bed-time. Oxide of zinc is very effective in night-sweats of phthisis. 
Oxide of zinc three grains and one-half grain of belladonna, given at bed- 
time. Picrotoxin from one hundred and eightieth to one-sixtieth of a grain, 
has been very successful. Pilocarpine in one-twentieth of a grain doses thrice 
daily, is often useful. Sponging with acidulated water, often effective. 

SYNOVITIS.— Blisters every night are useful. Cod=Iiver oil is useful if patient is 
debilitated. Iodine, applied to joint in chronic cases, riassage may be tried. 
Nitrate of silver in nitrous ether may be applied to the joint. Mercury and 
Morphia, oleate of, applied locally. 

TETANUS. — Bromide of potassium in large doses, one drachm every three or four 
hours is a remedy of great value. Morphine injected into the affected muscles 
gives relief. Paraldehyde given in sufficient quantity has often proved suc- 
cessful. The maximum dose (two and one-half drachms) has been given with- 
out ill effect. Chloral in large doses is of great value. Ether spray to spine 
every two hours. 

THIRST. — Hot drinks are of service. Ice, allowed to melt in the mouth, is useful. 
Acid drinks are effective to allay thirst in fevers. 

THRUSH.— Boracic acid solution mixed with honey Q) is very useful. Sulphur= 
ous acid solution, strong or diluted, applied locally. Salicylic acid, one part 
(dissolved in alcohol) to 250 of water. 

TOE NAIL, INGROWING.— Liquor potassae, two drachms to the ounce of water. 
A piece of cotton saturated with the solution is pressed under the ingrowing 
nail, repeated each morning; the nail becomes thin and can be pared away 
without pain. 

TOOTHACHE.— Opium or morphine (solution) dropped in the cavity. Oil of 
cloves, carbolic acid or resorcin in the decayed tooth are effective. Carbonate 
of soda (a saturated solution) held in the mouth stops the pain. 

ULCERS.— See Sores. 

URTICARIA. — Chloroform ointment for .the itching. Nitric acid, diluted, as a wash 
for itching. Alkaline washes should be used. Warm baths. 

VOMITING. — Alum in six to ten grain doses in obstinate vomiting of phthisical 
patients. Nux vomica and ipecac are useful when tongue is coated, florphine 
hypodermically. Mercury as gray powder, one-third of a grain every two 
hours. Lime water and milk in vomiting of infants. Chloroform, in drop 
doses. Bismuth, ten to fifteen grains every two hours, very effective in vomit- 
ing caused by gastric disturbance. Champagne or brandy, iced, in small doses 
frequently repeated, often useful. 
VULVITIS.— Lime water, locally. Alum, sixty grains to a pint of water, every two 

hours, as injection. Glycerine of Tannin can be used with advantage. 
WARTS. — Mercury, nitrate of, locally applied. Arsenious acid as caustic. 
Chromic acid, a solution of 100 grs. to the oz. applied carefully with a glass rod 



CLINICAL INDEX. 663 

to growth; dress with dry lint. Nitric acid one drachm or two of the dil. acid 
to a pint of water, as wash to keep warts constantly moist. 

WHOOPINQ=COUQH.— Belladonna, ten minims of tinct. each hour, to child three 
years old, especially during- third week if no complications. Chloroform or 
ether to lessen violence of paroxysms. Carbolic acid inhalations are some- 
times useful. Castanea, fluid extract in doses of one drachm t. i. d. 

WORMS. — Iron, tincture of the chloride, one-half ounce in a pint of water, a g-ood 
injection for thread worms, coagulating the albumen. Common salt, weak 
solution injected into the rectum for thread worms. Potassium bromide, five 
grain doses, t. i. d., in convulsions caused by worms. Areca nut, a half or 
whole nut is to be powdered and mixed with some syrup and swallowed for tape- 
worm. Chloroform in drachm doses taken in the morning - , fasting-, for tape- 
worm. Lime water injection for thread worms. Santonin, five grains for 
adults at bed- time for round worm. Turpentine as a poison to tape and thread 
worms. 



REE BIEE. 



Administration of anaesthetics $ 5 to $ 10 

Consultation visits 5 to SO 

Examination for life insurance 3 to .10 

Office prescription.. .50 to 2 

Expert testimonv (medico-legal) 

perday.. - 10 to 50 

Thorough examination in office. 5 to 10 

Microscopical examination of urine. 2 to 10 

Urine tested chemically 2 to 10 

Day visit in city 1.50 to 3 

Night visit in city 2 to 5 

Country visits, extra per mile. 1 

Vaccination... .50 to 1 

Visit in case of poisoning 5 to 10 

GENITO URINARY AND VEN- 
EREAL DISEASES. 

Gonorrhoea (in advance) — $ 15 to $ 20 

Syphilis (in advance) 25 to 100 

Sounding for stone in bladder 10 to 20 

Removing stone in bladder. 50 to 200 

External urethrotomy 50 to 250 

Internal urethrotomy- 25 to 75 

Urinary fistula.- 50 to 100 

Aspirating the bladder - 20 to 50 

Circumcision - 25 to 50 

Varicocele.. 20 to 75 

Tapping of hydrocele 10 to 15 

Radical cure of hydrocele - 25 to 75 

Phimosis or paraphimosis . 10 to 25 

OBSTETRICS AND GYNECOLOGY. 

Labor, ordinary cases $ 10 to $ 30 

Abortions- 10 to 50 

Instrumental delivery, additional..- 10 to 15 

Delivery of placenta 5 to 10 

Consultation 10 to 15 

Embryotomy -. 25 to 50 

Perineorrhaphy (primary) 10 to 30 

Perineorrhaphy (late) 25 to 100 

Laparotomy 50 to 200 

Ovariotomy 50 to 200 

Hysterectomy 150 to 500 

Hysterorrhaphy 100 to 300 

Amoutation of cervix 50 to 100 

Colporrhaphy 50 to 100 

Trachelorrhaphy 50 to 100 

Alexander's operation 50 to 150 

Curetting 25 to 75 

Removal of polypi - 25 to 75 

Removal of tumors of labia . 20 to 50 

Removal of urethral caruncle.. 25 to 100 

Colpocleisis 50 to 150 

Examination by speculum 5 to 10 

Endocervicitis, operation for 25 to 50 

Intrauterine douche 5 to 15 

Fitting of pessary... ,. 5 to 15 

Replacement of uterus 5 to 15 

Vesico-vaginal fissure, operation for 50 to 100 

Dilation of cervix in stenosis 15 to 25 

Atresia of vagina, operation for 50 to 150 

OPERATIVE SURGERY. 

Laparotomy $ 75 to $200 

Hemorrhoids, internal 25 to 75 

Hemorrhoids, external 10 to 50 

Hare-lip 25 to 100 

Excision of mammary gland 50 to 100 

Trephining- 100 to 200 

Removing large tumors 100 to 300 

Removing small tumors 30 to 100 

Staphylorrhaphy 50 to 100 

Nephrectomy 100 to 250 

Necrosis oi bone 25 to 50 

Fistula in ano 25 to 50 

Radical cure of hernia 100 to 150 

Strangulated hernia 100 to 200 

Strangulated hernia (reduced by 

taxis) 25to 50 

Polypus of rectum 25 to 50 

Anal fissure 25 to 50 

Hernia (Warren's operation) 25 to 75 

Varicose veins (radical cure) 25 to 50 

Aspiration of joints. 25 to 40 

Selecting and adjusting truss 5 to 10 



AMPUTATIONS. 

Knee $ 50 to $200 

Hip-joint... lOOto 200 

Leg.. 50to 150 

Foot 50 to 75 

Toes 25to 50 

Thigh lOOto 150 

Shoulder-joint 100 to 150 

Arm 50 to 100 

Hand.... 40 to 75 

Finger 15 to 30 

DISLOCATIONS. 

Shoulder $ 50 to $ 75 

Hip 50to 100 

Knee.. 25 to 75 

Ankle 25 to 50 

Arm... 25 to 50 

Maxillary bones 25 to 50 

Wrist 25to 40 

Toes lOto 25 

Fingers 10 to 25 

FRACTURES. 

Scapula $ 25 to $ 50 

Femur 50 to 100 

Fibula 25to 50 

Leg (both bones). 50 to 75 

Ribs 25to 50 

Humerus 25 to 50 

Radius or ulna 25 to 50 

Elbow-joint 25 to 50 

Nose 25to 60 

Smallbones 10 to 25 

Forearm (both bones) 50 to 75 

Coracoid or coronoid process 25 to 50 

Clavicle 50 to 75 

RESECTIONS. 

Ankle-joint or foot... $ 50 to $ 75 

Elbow $ 50to 75 

Femur (head of)... 100 to 200 

Knee 75 to 100 

Shoulder 75 to 100 

Maxilla 50 to 100 

Ribs 25to 50 

LIGATIONS. 

Brachial artery $ 50 to $ 75 

Subclavian or iliac artery.... 100 to 200 

Axillary, femoral, carotid, popliteal 

or poterior tibial artery 50 to 100 

All other arteries 20 to 40 

EYE. 

Sclerotomy $ 50 to $100 

Strabismus (each eye) 40 to 100 

Trachoma (each eye)... 50 to 100 

Canthotomy (each eye) '.. 40 to 75 

Opening lachrymal duct 25 to 50 

Cataract 100 to 250 

Artificial pupil (operation for) 50 to 100 

Pterygium (each eye) 50 to 100 

Tumor of lids 25 to 75 

Enucleation 100 to 200 

Astigmatism 25 to 50 

Glass fitting 10 to 20 

EAR. 

Polypus, removal of $ 50 to $ 75 

Foreign bodies, removal of 10 to 40 

Opening of mastoid bone 100 to 200 

NOSE, THROAT AND CHEST. 

Nasal tumors .$ 25 to $ 75 

Deflected septum.. 50 to 100 

Tonsil, excision of 25 to 75 

Uvula, excision of 25 to 50 

Tracheotomy 100 to 200 

Laryngeal tumors 50 to 200 

Adenoid vegetations -. -- 25 to ?5 

Larynx, intubation of 50 to 100 

Lungs, thorough examination of 5 to 10 






H?}/* 



